Race-Related Differences in Thrombogenicity: An Explanation for Disparities in COVID-19 Outcomes?

Background: As COVID-19 infection continues to spread, there are increasing reports about its differential impact on racial/ethnic minorities in the United States African Americans have worse clinical outcomes including hospitalization and mortality compared to Caucasians or Asians Role of racial/ethnic differences in inherent thromboinflammatory milieu with COVID-19 infection remains unexplored Methods: Medline, Cochrane Central Register of Controlled Trials, Embase, EBSCO, Web of Science, and CINAHL databases were searched for articles elaborating on COVID-19 pathophysiology and racial/ethnic differences in thrombotic biomarkers from inception through June 14, 2020 Data were used for qualitative analysis Findings: A total of 98 articles were included in the qualitative analysis COVID-19 infection is characterized as an immuno-thrombo-inflammatory syndrome with thrombotic microangiopathy strongly influencing clinical outcomes Several biomarkers have been associated with severe COVID-19 including markers of thrombosis/coagulation (e g D-dimer, prothrombin time, etc ) and inflammation (C-reactive protein, ferritin, etc ) In this review, we summarize the reported genetic differences in the inherent thromboinflammatory milieu among different populations with increased risk of thrombosis in African Americans and increased bleeding risk particularly in Asian populations We elaborate on the limitations of the traditional coagulation biomarkers and propose thromboelastography and rotational thromboelastometry to determine the dynamic functional clot characteristics Interpretation: Hemostasis profiling may provide clinically relevant information of thrombotic risk used to understand the racial disparities and could be used in personalizing antithrombotic treatment strategies in COVID-19 infection