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Review
. 2020 Nov;131(5):1324-1333.
doi: 10.1213/ANE.0000000000005147.

COVID-19-Associated Coagulopathy and Inflammatory Response: What Do We Know Already and What Are the Knowledge Gaps?

Klaus Görlinger  1   2 , Daniel Dirkmann  1 , Ajay Gandhi  3 , Paolo Simioni  4
Affiliations
Review

COVID-19-Associated Coagulopathy and Inflammatory Response: What Do We Know Already and What Are the Knowledge Gaps?

Klaus Görlinger et al. Anesth Analg. 2020 Nov.

Abstract

Patients with coronavirus disease 2019 (COVID-19) frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6), and immunity (such as lymphocyte count) as well as clinical scoring systems (such as sequential organ failure assessment [SOFA], International Society on Thrombosis and Hemostasis disseminated intravascular coagulation [ISTH DIC], and sepsis-induced coagulopathy [SIC] score) can be helpful in predicting clinical course, need for hospital resources (such as intensive care unit [ICU] beds, intubation and ventilator therapy, and extracorporeal membrane oxygenation [ECMO]) and patient's outcome in patients with COVID-19. However, therapeutic options are actually limited to unspecific supportive therapy. Whether viscoelastic testing can provide additional value in predicting clinical course, need for hospital resources and patient's outcome or in guiding anticoagulation in COVID-19-associated coagulopathy is still incompletely understood and currently under investigation (eg, in the rotational thromboelastometry analysis and standard coagulation tests in hospitalized patients with COVID-19 [ROHOCO] study). This article summarizes what we know already about COVID-19-associated coagulopathy and-perhaps even more importantly-characterizes important knowledge gaps.

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Conflict of interest statement

Potential Conflicts of Interest Klaus Görlinger, MD Klaus Görlinger is the Medical Director of Tem Innovations GmbH, Munich, Germany.

Daniel Dirkmann, MD, PhD Daniel Dirkmann attended acute care diagnostics strategic advisory committee meetings of Instrumentation Laboratory, Bedford, MA.

Ajay Ganghi, MD Ajay Gandhi is head of clinical affairs of Instrumentation Laboratory India.

Paolo Simioni, MD, PhD Paolo Simioni attended hemostasis strategic advisory committee meetings of Instrumentation Laboratory, Bedford, MA.

Figures

Figure 1.
Figure 1.
Pathophysiology of sepsis-induced coagulopathy (SIC)/COVID-19-associated coagulopathy and effects on viscoelastic testing variables (as shown in the in blue boxes). DAMPs, damage-associated molecular patterns; DIC, disseminated intravascular coagulation; IL-6, interleukin 6; MOF, multiple organ failure; NF-kappaB, nuclear factor kappa-light-chain-enhancer of activated B cells; PAI-1, plasminogen activator inhibitor type 1; PAMPs, pathogen-associated molecular patterns; PRRs, pattern recognition receptors; TF, tissue factor.
Figure 2.
Figure 2.
Thromboelastometry triad of thrombosis. VET, viscoelastic testing.
See this image and copyright information in PMC

References

    1. Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical presentation, and management of the pandemic coronavirus disease 2019 (COVID-19). Cureus. 2020;12:e7560. - PMC - PubMed
    1. Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18:1421–1424. - PMC - PubMed
    1. Malato A, Dentali F, Siragusa S, et al. The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Blood Transfus. 2015;13:559–568. - PMC - PubMed
    1. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–147. - PMC - PubMed
    1. Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020;18:1743–1746. - PMC - PubMed

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