COVID-19 related coagulopathy: what is known up to now

Abstract

: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has been a global challenge. The complicated forms of the Coronavirus Disease 2019 (COVID-19) can evolve to multiple-organ failure, including several coagulopathies related to a sudden worsening of respiratory status. This article aimed to review studies about hematological and hemostatic laboratory disorders directly related to COVID-19 and to discuss how SARS-CoV-2 causes these abnormalities. The coagulation cascade model is associated with both COVID-19 and pulmonary involvement. Laboratory changes are relevant to evaluate the coagulation state - D-dimer, prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), platelet count and fibrinogen. Pregnants and patients in Extracorporeal Membrane Oxygenation (ECMO) need special attention. Prophylactic interventions for COVID-19 coagulopathy should consider patients at risk for thrombotic events and potential contraindications. The mechanisms exerted by SARS-CoV-2 that impairs hemostatic balance include endothelial injury, inflammation, activation of the immune and complement systems. For diagnosis of coagulopathy, mainly Ddimer, but also PT, APTT and FDP, should be evaluated in COVID-19 patients. Intervention possibilities vary between lowmolecular-weight heparin (LMWH) and Unfractionated Heparin (UFH). Up to now, there is sufficient evidence that acutelyill patients with risk factors for coagulopathies will benefit from thrombophylaxis during hospitalization and post-discharge, but not all patients.