Coagulopathy in COVID‐19

The COVID‐19 pandemic has become an urgent issue in every country. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)‐like massive intravascular clot formation is frequently seen in this cohort. Therefore, coagulation t...

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Published in:Journal of thrombosis and haemostasis Vol. 18; no. 9; pp. 2103 - 2109
Main Authors: Iba, Toshiaki, Levy, Jerrold H., Levi, Marcel, Thachil, Jecko
Format: Journal Article
Language:English
Published: England Elsevier Limited 01.09.2020
John Wiley and Sons Inc
Subjects:
anticoagulant
Anticoagulants
Antithrombin
Biodegradation
Blood Coagulation
Blood Coagulation Disorders - blood
Blood Coagulation Disorders - complications
Blood Coagulation Tests
Cell death
coagulopathy
coronavirus
COVID-19
COVID-19 - complications
COVID-19 - epidemiology
Cytokines - metabolism
Degradation products
Disseminated intravascular coagulation
Disseminated Intravascular Coagulation - blood
Disseminated Intravascular Coagulation - complications
Fibrin
Fibrin - chemistry
Fibrin Fibrinogen Degradation Products - metabolism
Fibrinogen
Fibrinogen - chemistry
Fibrinolysis
Hemorrhage
Hemostasis
Humans
Hypoxia
Immune response
Inflammation
Lung - metabolism
Lung - virology
Lymphocytes
Lymphocytes - metabolism
Pandemics
Partial Thromboplastin Time
Protease Inhibitors
Prothrombin
Prothrombin Time
Review
Sepsis
Thrombocytopenia
Thromboembolism
Thromboplastin
Thrombosis
Thrombosis - metabolism
COVID-19
coronavirus
anticoagulant
coagulopathy
disseminated intravascular coagulation
ISSN:1538-7933, 1538-7836, 1538-7836
Online Access:Get full text
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Summary:The COVID‐19 pandemic has become an urgent issue in every country. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)‐like massive intravascular clot formation is frequently seen in this cohort. Therefore, coagulation tests may be considered useful to discriminate severe cases of COVID‐19. The clinical presentation of COVID‐19‐associated coagulopathy is organ dysfunction primarily, whereas hemorrhagic events are less frequent. Changes in hemostatic biomarkers represented by increase in D‐dimer and fibrin/fibrinogen degradation products indicate the essence of coagulopathy is massive fibrin formation. In comparison with bacterial‐sepsis‐associated coagulopathy/DIC, prolongation of prothrombin time, and activated partial thromboplastin time, and decrease in antithrombin activity is less frequent and thrombocytopenia is relatively uncommon in COVID‐19. The mechanisms of the coagulopathy are not fully elucidated, however. It is speculated that the dysregulated immune responses orchestrated by inflammatory cytokines, lymphocyte cell death, hypoxia, and endothelial damage are involved. Bleeding tendency is uncommon, but the incidence of thrombosis in COVID‐19 and the adequacy of current recommendations regarding standard venous thromboembolic dosing are uncertain.
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ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.14975