Ischemic Stroke and Acute Coronary Syndrome (ACS) in COVID-19 patients: Mechanisms and Role of Coagulopathy

Background: COVID-19 has a devastating impact on patients not only due to the severity of pulmonary disease but also the multitude of other manifestations. Objective: We discuss here myocardial ischemia and stroke, associated with COVID-19, from a hyper-coagulation perspective. Method: Original studies, case reports, and systematic reviews from different databases were studied for this review article. Results: Elevated inflammatory markers [e.g. ferritin, C-reactive protein, interleukins, antiphospholipid antibodies] together with elevated D-dimer levels point to an inflammatory source of activation of the coagulation cascade. Furthermore, the features of macro and microthrombi, because of dysregulated coagulation, point to local thrombosis as well as distant thrombo-embolism. Conclusion: Inflammation cascade and changes in coagulation markers leading to coagulopathy in COVID-19 patients emphasize the need to develop investigation techniques that can independently guide therapy.