Coagulation Disorders and Thrombotic Events in Patients with COVID-19: A Narrative Review.

Abstract

Background: This review explores the coagulation disorders and thrombotic events observed in COVID-19 patients, highlighting the underlying pathophysiological mechanisms and current management strategies.

Pathophysiology and clinical impact: Important mechanisms contributing to thrombosis include cytokine storm-induced thrombosis, antiphospholipid antibody syndrome, macrophage activation syndrome, complement cascade activation, and renin-angiotensin system dysregulation. Thrombotic complications significantly impact mortality and morbidity, with pulmonary emboli frequently observed in autopsy studies. Notably, this prothrombotic state may persist for weeks post-hospitalization.

Management: Effective management of COVID-19-associated coagulopathy requires prompt treatment of underlying infections and comprehensive assessment of co-infections in critically ill patients. While heparin and its derivatives remain the cornerstone for managing venous thromboembolism, their efficacy for COVID-19-associated coagulopathy remains to be a subject of investigation.

Conclusion: Understanding the complex interplay between inflammation and thrombosis in COVID-19 is crucial for developing targeted therapeutic strategies that address coagulation disorders and the underlying infection.