COVID-19 and its implications for thrombosis and anticoagulation

Area of Science:

• Hematology
• Infectious Diseases
• Critical Care Medicine

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, often associated with coagulopathy.
• This coagulopathy shares features with disseminated intravascular coagulopathy (DIC), characterized by elevated D-dimer and fibrin/fibrinogen degradation products.
• The global impact of COVID-19 necessitates understanding and managing its associated complications, including multi-organ failure.

Purpose of the Study:

• To describe the coagulopathy associated with COVID-19.
• To outline recommended screening and management strategies for COVID-19-associated coagulopathy.
• To differentiate COVID-19 coagulopathy from other thrombotic and bleeding disorders.

Main Methods:

• Review of clinical presentations and laboratory findings in COVID-19 patients.
• Analysis of coagulation test abnormalities, including D-dimer, fibrinogen, prothrombin time, and partial thromboplastin time.
• Comparison of COVID-19 coagulopathy with sepsis-induced coagulopathy and DIC.

Main Results:

• Initial COVID-19 coagulopathy typically shows elevated D-dimer and fibrin/fibrinogen degradation products, with less common abnormalities in PT, PTT, and platelet counts.
• Elevated D-dimer, sepsis physiology, and consumptive coagulopathy are mortality indicators.
• Bleeding manifestations are uncommon, even in patients with DIC.

Conclusions:

• Coagulation screening, including D-dimer and fibrinogen levels, is recommended for COVID-19 patients.
• Management should align with established practices for critically ill patients, including thromboembolic prophylaxis.
• Full-intensity anticoagulation is not routinely indicated unless clinically warranted; standard guidelines apply if bleeding occurs.