Coagulopathy of Coronavirus Disease 2019

Recent studies have reported a high prevalence of thrombotic events in coronavirus disease 2019. However, the significance of thromboembolic complications has not been widely appreciated. The purpose of this review is to provide current knowledge of this serious problem. Narrative review. Online sea...

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Veröffentlicht in:Critical care medicine Jg. 48; H. 9; S. 1358
Hauptverfasser: Iba, Toshiaki, Levy, Jerrold H, Levi, Marcel, Connors, Jean Marie, Thachil, Jecko
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.09.2020
Schlagworte:
Anticoagulants - therapeutic use
Betacoronavirus
Blood Coagulation Disorders - epidemiology
Blood Coagulation Disorders - etiology
Blood Coagulation Disorders - prevention & control
Coronavirus Infections - complications
Coronavirus Infections - physiopathology
COVID-19
Disseminated Intravascular Coagulation - etiology
Female
Humans
Male
Pandemics
Platelet Aggregation Inhibitors - therapeutic use
Pneumonia, Viral - complications
Pneumonia, Viral - physiopathology
Pregnancy
Prevalence
SARS-CoV-2
Thromboembolism - etiology
Thrombophilia - etiology
ISSN:1530-0293, 1530-0293
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Zusammenfassung:Recent studies have reported a high prevalence of thrombotic events in coronavirus disease 2019. However, the significance of thromboembolic complications has not been widely appreciated. The purpose of this review is to provide current knowledge of this serious problem. Narrative review. Online search of published medical literature through PubMed using the term "COVID-19," "SARS," "acute respiratory distress syndrome," "coronavirus," "coagulopathy," "thrombus," and "anticoagulants." Articles were chosen for inclusion based on their relevance to coagulopathy and thrombosis in coronavirus disease 2019, and anticoagulant therapy. Reference lists were reviewed to identify additional relevant articles. Coronavirus disease 2019 is associated with a strikingly high prevalence of coagulopathy and venous thromboembolism that may contribute to respiratory deterioration. Monitoring coagulation variables is important, as abnormal coagulation tests are related to adverse outcomes and may necessitate adjuvant antithrombotic interventions. In the initial phase of the infection, D-dimer and fibrinogen levels are increased, while activated partial prothrombin time, prothrombin time, and platelet counts are often relatively normal. Increased D-dimer levels three times the upper limit of normal may trigger screening for venous thromboembolism. In all hospitalized patients, thromboprophylaxis using low-molecular-weight heparin is currently recommended. The etiology of the procoagulant responses is complex and thought to be a result of specific interactions between host defense mechanisms and the coagulation system. Although the coagulopathy is reminiscent of disseminated intravascular coagulation and thrombotic microangiopathy, it has features that are markedly distinct from these entities. Severe acute respiratory syndrome coronavirus 2/coronavirus disease 2019 frequently induces hypercoagulability with both microangiopathy and local thrombus formation, and a systemic coagulation defect that leads to large vessel thrombosis and major thromboembolic complications, including pulmonary embolism in critically ill hospitalized patients. D-dimers and fibrinogen levels should be monitored, and all hospitalized patients should undergo thromboembolism prophylaxis with an increase in therapeutic anticoagulation in certain clinical situations.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
ObjectType-Review-3
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ISSN:1530-0293
1530-0293
DOI:10.1097/CCM.0000000000004458