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COVID-19-related coagulopathy: A review of pathophysiology and pharmaceutical management
Mahdi Kohansal Vajari1, Mahsa Shirin1, Atieh Pourbagheri-Sigaroodi1
1Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
The novel coronavirus (SARS-CoV-2) causes COVID-19, leading to severe coagulopathy and nonpulmonary organ injury. Understanding COVID-19 coagulopathy pathogenesis and management is crucial for patient outcomes.
Area of Science:
- Medicine
- Virology
- Hematology
Background:
- The 2019 emergence of SARS-CoV-2 caused a global pandemic.
- COVID-19 presents with pneumonia but also significant coagulopathy and nonpulmonary organ damage.
- Coagulopathy in COVID-19 is linked to inflammation, endothelial dysfunction, and complement activation.
Purpose of the Study:
- To review the pathogenesis, clinical manifestations, and laboratory findings of COVID-19-associated coagulopathy.
- To summarize current and proposed management strategies for COVID-19 coagulopathy.
Main Methods:
- Literature review of studies on COVID-19 coagulopathy.
- Analysis of factors contributing to coagulation dysfunction in COVID-19 patients.
- Synthesis of information on diagnostic and therapeutic approaches.
Main Results:
- Coagulopathy is a significant factor in severe COVID-19, contributing to mortality.
- Key pathogenic factors include inflammation, endothelial dysfunction, and complement activation.
- Assessment of coagulation parameters aids in early diagnosis and severity prediction.
Conclusions:
- COVID-19 coagulopathy is complex, involving multiple pathophysiological pathways.
- Effective management strategies are essential to mitigate coagulopathy-related complications.
- Low-molecular-weight heparin is a primary treatment, with other options under investigation.
Abstract:
December 2019 will never be forgotten in the history of medicine when an outbreak of pneumonia of unknown etiology in Wuhan, China sooner or later prompted the World Health Organization to issue a public health warning emergency. This is not the first nor will it be the last time that a member of β-coronaviruses (CoVs) is waging a full-scale war against human health. Notwithstanding the fact that pneumonia is the primary symptom of the novel coronavirus (2019nCoV; designated as SARS-CoV-2), the emergence of severe disease mainly due to the injury of nonpulmonary organs at the shadow of coagulopathy leaves no choice, in some cases, rather than a dreadful death. Multiple casual factors such as inflammation, endothelial dysfunction, platelet and complement activation, renin-angiotensin-aldosterone system derangement, and hypoxemia play a major role in the pathogenesis of coagulopathy in coronavirus disease 2019 (COVID-19) patients. Due to the undeniable role of coagulation dysfunction in the initiation of several complications, assessment of coagulation parameters and the platelet count would be beneficial in early diagnosis and also timely prediction of disease severity. Although low-molecular-weight heparin is considered as the first-line of treatment in COVID-19-associated coagulopathy, several possible therapeutic options have also been proposed for better management of the disease. In conclusion, this review would help us to gain insight into the pathogenesis, clinical manifestation, and laboratory findings associated with COVID-19 coagulopathy and would summarize management strategies to alleviate coagulopathy-related complications.
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