Pulmonary Thrombosis in Acute Respiratory Distress Syndrome: Theory, Evidence, and Clinical Relevance to Resource-Limited Settings

Abstract

Thrombosis is often seen in acute respiratory distress syndrome (ARDS) patients, increasing morbidity and mortality. This review highlights the pathophysiology of ARDS and how it links to pulmonary thrombosis. Understanding this link is furthermore critical as pulmonary thrombosis a serious issue in coronavirus diseases, such as COVID-19. There is a clear link between ARDS pathophysiology and pulmonary thrombosis as defined by the “two-path unifying theory” and “two-activation theory of the endothelium”. Interestingly, ARDS in influenza versus COVID-19 patients have a slightly different pathophysiology, the latter having more compact fibrin clots that are more difficult to dissolve; this will impact the treatment of COVID-19 ARDS patients. We therefore also reviewed the current treatment options, underlining that potentially life-saving thrombosis-screening procedures could be lacking in resource-limited settings, therefore needing redress.