Coagulation/Fibrinolysis and Thrombosis in Coronavirus Disease 2019: A Review Based on Up-To-Date Knowledge

Abstract

Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that developed into an ongoing pandemic. The main pathology of COVID-19 is viral pneumonia, but thrombotic complications are frequently observed and are associated with its severity. Methods: We selected qualitatively and quantitatively reliable reports, which were related to thrombosis and were associated with COVID-19, using the Google Scholar and PubMed search engines. The features of abnormal coagulation/fibrinolysis and thrombosis were reviewed based on these reports. Results: Thrombosis accompanying COVID-19 can occur in veins, arteries, and capillaries. Macrothrombosis and microthrombosis can also occur. Furthermore, the patterns of disseminated intravascular coagulation that accompany COVID-19 can vary from the fibrinolysis-suppressing to the fibrinolysis-enhancing type. Discussion: Coagulation/fibrinolysis abnormalities in patients with COVID-19 should be investigated over time using many markers, including D-dimer levels. Based on the obtained results, prospective randomized clinical trials on antithrombotic drugs should be conducted to establish an effective treatment. Conclusion: Further elucidation of the characteristic pathology of coagulation/fibrinolysis and thrombosis in patients with COVID-19 is expected, which would lead to the development of appropriate treatments.