Title:COVID-19 Related Coagulopathy: What is Known Up to Now
Volume: 28
Issue: 21
Author(s): Ana Luísa Batista Pena, Rafael Arantes Oliveira, Renata Gomes Severo and Ana Cristina Simões e Silva*
Affiliation:
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais,Brazil
Keywords:
COVID-19, Coagulation, Coagulopathy, Acute respiratory distress syndrome, Angiotensin-converting
enzyme 2, SARS-CoV-2.
Abstract: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has
been a global challenge. The complicated forms of the Coronavirus Disease 2019 (COVID-
19) can evolve to multiple-organ failure, including several coagulopathies related to a sudden
worsening of respiratory status. This article aimed to review studies about hematological and
hemostatic laboratory disorders directly related to COVID-19 and to discuss how SARS-CoV-
2 causes these abnormalities. The coagulation cascade model is associated with both COVID-
19 and pulmonary involvement. Laboratory changes are relevant to evaluate the coagulation
state - D-dimer, prothrombin time (PT), Activated Partial Thromboplastin Time (APTT),
platelet count and fibrinogen. Pregnant women and patients in Extracorporeal Membrane
Oxygenation (ECMO) need special attention. Prophylactic interventions for COVID-19 coagulopathy
should consider patients at risk for thrombotic events and potential contraindications.
The mechanisms exerted by SARS-CoV-2 that impairs hemostatic balance include endothelial
injury, inflammation, and activation of the immune and complement systems. For
diagnosis of coagulopathy, mainly D-dimer, but also PT, APTT and FDP, should be evaluated
in COVID-19 patients. Intervention possibilities vary between low-molecular-weight heparin
(LMWH) and Unfractionated Heparin (UFH). Until now, there is sufficient evidence that
acutely-ill patients with risk factors for coagulopathies will benefit from thrombophylaxis during
hospitalization and post-discharge, but not all patients.
