Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jan;113(1):45-57.
doi: 10.1007/s12185-020-03029-y. Epub 2020 Nov 7.

COVID-19-associated coagulopathy and disseminated intravascular coagulation

Hidesaku Asakura  1 , Haruhiko Ogawa  2
Affiliations
Review

COVID-19-associated coagulopathy and disseminated intravascular coagulation

Hidesaku Asakura et al. Int J Hematol. 2021 Jan.

Abstract

The pathology of coronavirus disease 2019 (COVID-19) is exacerbated by the progression of thrombosis, and disseminated intravascular coagulation (DIC), and cytokine storms. The most frequently reported coagulation/fibrinolytic abnormality in COVID-19 is the increase in D-dimer, and its relationship with prognosis has been discussed. However, limits exist to the utility of evaluation by D-dimer alone. In addition, since the coagulation/fibrinolytic condition sometimes fluctuates within a short period of time, regular examinations in recognition of the significance of the examination are desirable. The pathophysiology of disseminated intravascular coagulation (DIC) associated with COVID-19 is very different from that of septic DIC, and both thrombotic and hemorrhagic pathologies should be noted. COVID-19 thrombosis includes macro- and microthrombosis, with diagnosis of the latter depending on markers of coagulation and fibrinolysis. Treatment of COVID-19 is classified into antiviral treatment, cytokine storm treatment, and thrombosis treatment. Rather than providing uniform treatment, the treatment method most suitable for the severity and stage should be selected. Combination therapy with heparin and nafamostat is expected to develop in the future. Fibrinolytic therapy and adsorption therapy require further study.

Keywords: COVID-19; Cytokine storm; DIC; Disseminated intravascular coagulation; SARS-CoV-2; Thrombosis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Time-dependent changes in coagulation and fibrinolytic markers in COVID-19 (modified from Reference [6]. PT prothrombin time, APTT activated partial thromboplastin time, DD d-dimer, FDP fibrin/fibrinogen degradation products, Fbg fibrinogen, AT antithrombin
Fig. 2
Fig. 2
Sites of thrombosis and bleeding in COVID-19. (Quoted from Reference [23]
Fig. 3
Fig. 3
Stage of COVID-19 and concept of treatment (created by the authors)
See this image and copyright information in PMC

References

    1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. - PMC - PubMed
    1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. - PMC - PubMed
    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. - PMC - PubMed
    1. Takahashi T, Ellingson MK, Wong P, Israelow B, Lucas C, Klein J, et al. Sex differences in immune responses that underlie COVID-19 disease outcomes. Nature. 2020 doi: 10.1038/s41586-020-2700-3. - DOI - PMC - PubMed
    1. Zhao J, Yang Y, Huang H, Li D, Gu D, Lu X, et al. Relationship between the ABO blood group and the COVID-19 susceptibility. Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa1150. - DOI - PMC - PubMed

MeSH terms