RSV Infection and Thrombosis Risk
Based on the current evidence, RSV infection does not appear to directly cause thrombosis as a common complication, unlike COVID-19 which has well-documented thrombotic risks. 1
Cardiovascular Complications of RSV
RSV infection is associated with several cardiovascular complications, but thrombosis is not specifically identified as one of them:
Acute cardiac events occur in 22.4% of adults ≥50 years hospitalized with RSV infection 2, including:
- Acute heart failure (15.8%)
- Acute ischemic heart disease (7.5%)
- Hypertensive crisis (1.3%)
- Ventricular tachycardia (1.1%)
- Cardiogenic shock (0.6%)
Patients with underlying cardiovascular disease have a significantly higher risk of experiencing these cardiac events (33.0% vs 8.5%) 2
These cardiac complications are associated with worse outcomes:
- Higher risk of ICU admission (25.8% vs 16.5%)
- Increased in-hospital mortality (8.1% vs 4.0%)
Hematological Effects of RSV
While RSV is not directly linked to thrombosis, it can affect blood parameters:
- RSV infection has been associated with thrombocytosis (platelet count >500 x 10^9/L), particularly in pediatric patients 3
- This is different from the thrombotic complications seen in COVID-19, which include:
Risk Stratification
Patients with RSV who may need closer monitoring for cardiovascular complications (though not specifically thrombosis) include those with:
- Pre-existing heart failure (4.0-33.2 times higher hospitalization risk) 1, 7
- Coronary artery disease (3.7-7.0 times higher hospitalization risk) 1, 7
- History of stroke (though evidence is mixed) 1
Clinical Implications
When managing patients with RSV infection:
- Monitor for cardiac complications, particularly in those with pre-existing cardiovascular disease
- Unlike COVID-19, routine thromboprophylaxis specifically for RSV is not indicated based on current evidence
- Standard thromboprophylaxis guidelines for hospitalized patients should be followed based on individual risk factors
Pitfalls to Avoid
- Do not confuse the thrombotic risk profile of RSV with that of COVID-19, which has a well-established association with thrombotic complications
- While RSV can cause significant cardiovascular complications, these primarily manifest as heart failure exacerbations and ischemic events rather than primary thrombotic events
- Thrombocytosis associated with RSV infection (particularly in children) should not be confused with a prothrombotic state
In summary, while RSV infection can cause significant cardiovascular complications, particularly in those with underlying heart disease, there is no strong evidence that it directly causes thrombosis as a common complication.