Current evidence on COVID-19 and coagulopathy

On late December 2019, an outbreak of a novel coronavirus (SARS-CoV-2) causing severe pneumonia (COVID-19) was reported in Wuhan, Hubei Province, China and then in all around the world. Data suggest that a lung-centric and systemic coagulopathy may play an important role. Elevated D-dimer levels which correlated inversely with overall survival were recently reported in Chinese studies. Critically however, severe COVID-19 infection is associated with a significant coagulopathy that correlates with disease severity and a 3-4-fold higher mortality risk. COVID-19 patients with acute respiratory failure present a severe hypercoagulability rather than consumptive coagulopathy. Fibrin formation and polymerization may predispose to thrombosis and correlate with a worse outcome. However, increasing the prophylaxis towards high prophylactic doses to the patients admitted to the ICU, going from enoxaparin 40 mg OD to 40 mg BID, prevents major vascular complications and reduces mortality rate.