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Thrombosis and coagulopathy in COVID-19: An illustrated review

Marcel Levi1, Beverley J Hunt2

  • 1Department of Medicine and Cardiometabolic Programme-NIHR UCLH/UCL BRC University College London Hospitals NHS Foundation Trust London UK.

Research and Practice in Thrombosis and Haemostasis
|July 21, 2020
PubMed

Insights

Severe coronavirus disease 2019 (COVID-19) involves significant haemostatic changes, including high D-dimers and venous thromboembolism, driven by inflammation and coagulation crosstalk. Pulmonary immunothrombosis is also a notable complication in severe COVID-19 patients.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Pulmonology

Background:

  • Severe coronavirus disease 2019 (COVID-19) is associated with complex physiological changes.
  • Understanding haemostatic alterations in severe COVID-19 is crucial for patient management.
  • The interplay between inflammation and coagulation in critical illness requires further elucidation.

Purpose of the Study:

  • To review the haemostatic changes observed in patients with severe COVID-19.
  • To explore the underlying causes of these haemostatic alterations.
  • To highlight the occurrence of venous thromboembolism and pulmonary immunothrombosis in severe COVID-19.

Main Methods:

  • Literature review of haemostatic changes in severe COVID-19.
  • Analysis of the relationship between inflammation and coagulation pathways.
  • Discussion of clinical findings related to thrombosis in acute lung injury.

Main Results:

  • Severe COVID-19 exhibits significant haemostatic changes, including elevated acute-phase proteins and very high D-dimer levels.
  • Disseminated intravascular coagulation is typically absent, despite hypercoagulable state.
  • High rates of venous thromboembolism and pulmonary immunothrombosis are observed in severe COVID-19.

Conclusions:

  • Haemostatic changes in severe COVID-19 result from inflammation-coagulation crosstalk.
  • Pulmonary immunothrombosis represents a significant, previously under-described complication.
  • These findings underscore the need for vigilant monitoring and management of thrombotic risks in severe COVID-19.

Keywords:
COVID‐19coagulationcoagulopathynovel coronavirusthrombosis

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