COVID-19-induced coagulopathy: Experience, achievements, prospects

Abstract

The presence of coagulopathy as part of the systemic inflammatory response syndrome is a characteristic feature of severe coronavirus disease 2019 (COVID-19). Hematological changes (increased D-dimer [DD], prolonged activated partial thromboplastin clotting time [APTT] and prothrombin time [PT], high fibrinogen levels) have been observed in hospitalized patients with COVID-19, which characterize the risk of thrombotic events. Against the background of COVID-19 there is endothelial dysfunction, hypoxia and pulmonary congestion, mediated by thrombosis and microvascular occlusion. Up to 71.4% of patients who died from COVID-19 had disseminated intravascular coagulation syndrome, compared with only 0.6% of survivors. The main manifestation of COVID-19-associated coagulopathy is a significant increase in DD without a decrease in platelet count or prolongation of APTT and PT, indicating increased thrombin formation and the development of local fibrinolysis. An increase in DD levels of more than 3-4 times was associated with higher in-hospital mortality. Therefore, COVID-19 requires assessment of the severity of the disease for further tactics of thromboprophylaxis. The need for continued thromboprophylaxis, or therapeutic anticoagulation, in patients after inpatient treatment for two weeks using imaging techniques to assess of thrombosis assessment.

Keywords: COVID-19-induced coagulopathy; SARS-CoV-2; coronavirus disease 2019 (COVID-19) infection.

Figure 1

Algorithm for the use of anticoagulants in coronavirus disease 2019 (COVID-19) patients with ≤ 18 years who have already taken an anticoagulant. Heparin resistance in COVID-19: if the heparin dose is > 25 IU/kg/day and there is no activated partial thromboplastin clotting time prolongation anti-Xa monitoring at the level of 0.3–0.7 IU/mL; DD — D-dimer; ECMO — extracorporeal membrane oxygenation; PE — pulmonary embolism; VTE — venous thromboembolism.

Central illustration

Mechanism of thrombus formation during COVID-19 infection; DAMP — danger/damage associated molecular patterns; SARS-CoV-2 — severe acute respiratory syndrome coronavirus 2.