COVID-19-associated coagulopathy and disseminated intravascular coagulation

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

Incidence and impact of disseminated intravascular coagulation in COVID-19 a systematic review and meta-analysis

“…For example, D-dimer is an excellent marker, but shows limitations in assessing the pathophysiology of the coagulation abnormalities seen in COVID-19. Similarly, the treatment of COVID-19 should be used according to the pathophysiological condition [ 37 ]. Recently, evidence has shown the application of heparin sodium and LMWH inhibits blood coagulation, reduces inflammation, and inhibits platelet aggregation, thereby preventing thrombosis and delaying coagulopathy progression to DIC in high-risk patients [ 13 , 20 , 30 ].…”

Fatal pulmonary arterial thrombosis in a COVID-19 patient, with asymptomatic history, occurred after swab negativization

“…Acute respiratory distress syndrome and multiple organ failure are features of severe cases of COVID-19 [ 1 ]. Hypercoagulable condition, accompanied by thrombosis and disseminated intravascular coagulation, may determine progression to multiple-organ failure and death [ 2 ]. The association of COVID-19 with clinically significant coagulopathies and multiple infarcts has been described [ 3 ], thus an appropriate evaluation and interventions to prevent and treat thromboembolic complications in patients showing coagulopathy, is matter of interest [ 4 ].…”

Myoglobin and C-reactive protein are efficient and reliable early predictors of COVID-19 associated mortality

“…The analysis of recently published studies reveals the role of systemic vasculitis and cytokine-mediated coagulation disorders, predominantly responsible for multi-organ failure in patients with severe COVID-19 complications. The hematological (lymphocyte count 11,12 , neutrophil count 13 , neutrophil-lymphocyte ratio (NLR)) 14,15 , inflammatory (C-reactive protein (CRP)) 16 , immunological (interleukin (IL)-6) 17 and biochemical (D-dimer 18 , troponin, creatine kinase (CK) 19 biomarkers, as well as procalcitonin (PCT) 16,20 , erythrocyte sedimentation rate (ESR) 21 , aspartate aminotransferase (AST)) 22 , and those particularly related to coagulation cascades in disseminated intravascular coagulation (DIC) 23 and acute respiratory distress syndrome (ARDS) 24 have been reported to be important biomarkers associated with COVID-19 disease. New laboratory biomarkers could be identified through the accurate analysis of multicentric case series; in particular, homocysteine and angiotensin II could play a significant role in this regard 24 .…”