Coagulopathy in COVID-19

Authors: Iba T, Levy JH, Levi M, Thachil J.

Publication: J Thromb Haemost.; June 2020

Affiliations: Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA; University College London Hospitals NHS Foundation Trust, Department of Medicine, and Cardio-metabolic Programme-NIHR UCLH/UCL BRC London, London, UK; Department of Haematology, Manchester Royal Infirmary, Manchester, UK.

Abstract: 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, while 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.