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Published on: September 9, 2012
COVID-19 coagulopathy: is it disseminated intravascular coagulation?
Marcel Levi1,2, Toshiaki Iba3
1Department of Medicine, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK. marcel.levi@nhs.net.
Insights
Severe COVID-19 causes a unique coagulopathy, distinct from disseminated intravascular coagulation (DIC). This distinct syndrome involves pulmonary microangiopathy and endothelial injury, potentially requiring new diagnostic criteria for COVID-19-related thrombosis.
Area of Science:
- Medical Research
- Infectious Diseases
- Hematology
Background:
- Severe COVID-19 is associated with significant coagulopathy.
- This coagulopathy contributes to venous and arterial thromboembolic events.
- Observed coagulation changes resemble, but are not identical to, disseminated intravascular coagulation (DIC).
Purpose of the Study:
- To investigate the distinct coagulopathic features in severe COVID-19.
- To differentiate COVID-19-associated coagulopathy from disseminated intravascular coagulation (DIC).
- To explore the role of pulmonary thrombotic microangiopathy and endothelial injury in COVID-19 coagulopathy.
Main Methods:
- Analysis of coagulation profiles in severe COVID-19 patients.
- Comparison of COVID-19 coagulopathy with established DIC criteria.
- Evaluation of evidence for pulmonary microangiopathy and direct viral effects on endothelium.
Main Results:
- Most severe COVID-19 patients do not meet standard DIC criteria.
- Evidence suggests a strong local pulmonary thrombotic microangiopathy.
- Direct endothelial cell infection and injury by SARS-CoV-2 contribute to the coagulopathic response.
Conclusions:
- COVID-19 induces a distinct intravascular coagulation syndrome.
- This syndrome differs significantly from typical disseminated intravascular coagulation (DIC).
- Separate diagnostic criteria may be necessary for COVID-19-related coagulopathy.
Abstract:
One of the significant complications of severe COVID-19 infections is a coagulopathy that seems to be related to the occurrence of venous and arterial thromboembolic disease. The coagulation changes mimic but are not identical to disseminated intravascular coagulation (DIC). The vast majority of patients with COVID-19 do not meet the criteria for usual forms of DIC. In addition, there seem to be features of a strong local pulmonary thrombotic microangiopathy and direct endothelial cell infection and injury by the virus that affect the coagulopathic response to severe COVID-19. It seems COVID-19 leads to a distinct intravascular coagulation syndrome that may need separate diagnostic criteria.
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