COVID-19 related coagulopathy: what is known up to now

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. Pregnants 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, activation of the immune and complement systems. For diagnosis of coagulopathy, mainly Ddimer, but also PT, APTT and FDP, should be evaluated in COVID-19 patients. Intervention possibilities vary between lowmolecular-weight heparin (LMWH) and Unfractionated Heparin (UFH). Up to now, there is sufficient evidence that acutelyill patients with risk factors for coagulopathies will benefit from thrombophylaxis during hospitalization and post-discharge, but not all patients.

Lupus anticoagulant-hypoprothrombinemia syndrome with severe bleeding diathesis after coronavirus disease 2019: a case report

“…To our knowledge, this is the first case of LAHPS with severe bleeding diathesis strongly associated with previous COVID-19 infection. This case adds to the complexity of COVID-19-related coagulopathy, which includes immune, endothelial, and coagulation systems, and calls attention to the possibility of bleeding complications, especially in patients using therapeutic anticoagulants ( 1 - 3 ).…”

“…Most common coagulation abnormalities in COVID-19 patients are elevated D-dimer levels and fibrin split products ( 2 ). Other coagulation abnormalities, such as low fibrinogen levels, prolonged prothrombin time, and low platelet count, have also been reported ( 3 ). Despite all these derangements in coagulation tests, abnormal bleeding is uncommon.…”

The influence of pre-admission antiplatelet and anticoagulation therapy on the illness severity in hospitalized patients with COVID-19 in Japan

“…Coronavirus disease 2019 (COVID-19) first emerged in Wuhan, China, in December 2019 and subsequently spread globally [1]. Many articles have reported that it causes coagulation abnormalities and pulmonary thrombosis, contributing to poorer prognosis [2,3]. The prognosis of COVID-19 is improved by the use of anticoagulant agents during hospitalization [4].…”

Looking for pathways related to COVID-19 phenotypes: Confirmation of pathogenic mechanisms by SARS-CoV-2 - Host interactome

“…For KEGG database the gene enrichment analysis on interactomes of NS7b, ORF1a, ORF3a and ORF8 showed pathway clusters highly significant and consistent with possible pathogenic mechanisms, such as the activation of the complement and of the coagulative cascade, (29) and the TGF-β-dominated immune response (30). In particular, the NS7b interactome revealed SNARE interactions in vesicular transport pathway, describing the mechanisms of intracellular vesicle trafficking and secretion, as the most significant pathway among all interactome (FDR< 0.…”