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Published on: May 23, 2025
Proposal of the Definition for COVID-19-Associated Coagulopathy
Toshiaki Iba1, Theodore E Warkentin2,3, Jecko Thachil4
1Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
Insights
COVID-19-associated coagulopathy (CAC) shares similarities with disseminated intravascular coagulation (DIC). Despite differences, CAC can be viewed as a thrombotic phenotype of DIC due to systemic coagulation activation.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Thrombotic events are frequent in COVID-19, affecting both large vessels and microvasculature.
- COVID-19-associated coagulopathy (CAC) presents unique features but shares similarities with disseminated intravascular coagulation (DIC).
Purpose of the Study:
- To review current knowledge on CAC, comparing its similarities and differences with sepsis-associated DIC.
- To explore the debate on whether CAC constitutes a form of DIC.
Main Methods:
- Literature review of studies on COVID-19 coagulopathy and DIC.
- Analysis of reported mechanisms of CAC, including immune and complement system activation.
- Comparison of clinical and laboratory findings between CAC and DIC.
Main Results:
- CAC involves activated coagulation, endotheliopathy, and immune system dysregulation.
- Pathological findings in COVID-19 align with the definition of DIC: systemic coagulation activation secondary to microvascular damage.
- Despite distinct clinical presentations, fundamental similarities exist between CAC and DIC.
Conclusions:
- COVID-19-associated coagulopathy can be considered a thrombotic phenotype of DIC.
- Understanding CAC as a form of DIC provides insights into its pathophysiology and management.
- Further research is needed to fully elucidate the relationship between CAC and DIC.
Abstract:
Thrombotic events are common complications in COVID-19 patients that include both thrombus formation in large vessels and the microvasculature of the lung and other organs. COVID-19-associated coagulopathy (CAC) and disseminated intravascular coagulation (DIC) have similarities and differences, and whether CAC is a form of DIC is the subject of debate. Reported mechanisms of CAC include activated coagulation, endotheliopathy, up-regulated innate and adaptive immunity, and activated complement system. Although the clinical features and laboratory findings of CAC and DIC seem different, there are fundamental similarities that should be considered. Basically, the pathological findings of COVID-19 fall within the scope of the definition of DIC, i.e., systemic activation of coagulation caused by or resulting from the microvascular damage. Therefore, we suggest that although CAC differs from usual infection-associated DIC, its various features indicate that it can be considered a thrombotic phenotype DIC. This review summarizes the current knowledge about CAC including differences and similarities with sepsis-associated DIC.
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