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Review
. 2020 Oct;36(4):616-626.
doi: 10.1007/s12288-020-01328-2. Epub 2020 Aug 11.

Hemostatic Abnormalities in COVID-19: An Update

Mukul Aggarwal  1 , Jasmita Dass  1 , Manoranjan Mahapatra  1
Affiliations
Review

Hemostatic Abnormalities in COVID-19: An Update

Mukul Aggarwal et al. Indian J Hematol Blood Transfus. 2020 Oct.

Abstract

COVID-19 has emerged as a pandemic with lung being the primarily afflicted organ. Deranged hemostasis has been observed in patients with COVID-19 with scales tipped towards a prothrombotic state. The pathogenesis differs from disseminated intravascular coagulation with a primary pulmonary localization. This is referred to as pulmonary intravascular coagulopathy with strong component of thrombo-inflammation. This is reflected in the lab tests with an increase in D-dimer which correlates with severity and outcomes of disease. Common coagulation tests such as prothrombin time, activated partial thromboplastin time are only mildly prolonged while most patients have normal to increased fibrinogen and marginal thrombocytopenia. Overall, the patients have an increase in venous and arterial thrombotic events especially in ICU patients. Routine thromboprophylaxis with low molecular weight heparin is recommended in all hospitalized patients to reduce the incidence of thrombosis. Bleeding is uncommon and treated with blood products transfusion. This review shall discuss the hemostatic abnormalities in COVID-19 patients and their impact on prognosis. In addition, strategy of thromboprophylaxis and various academic society guidelines are discussed in detail.

Keywords: COVID associated coagulopathy; COVID-19; D-dimer; Pulmonary intravascular coagulopathy; Thrombosis.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
Pathogenesis of pulmonary intravascular coagulopathy (PIC) and thrombosis
Fig. 2
Fig. 2
Differences between COVID-19 coagulopathy from disseminated intravascular coagulation
See this image and copyright information in PMC

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