Journal
SHOCK
Volume 55, Issue 6, Pages 700-716Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SHK.0000000000001680
Keywords
Coagulation; coagulopathy; COVID-19; DVT; pulmonary embolism; thromboembolism; thrombosis
Funding
- National Institute of Aging and Robert and Arlene Kogod Center for Aging, Mayo Clinic [T32 AG049672]
- National Heart, Lung, and Blood Institute [R38HL150086]
- National Institute of General Medical Sciences [R01 GM 126086-03]
- National Center for Research Resources (NCRR) [1UL1 RR024150]
- National Center forA dvancing Translational Sciences [UL1 TR000135]
- Trans-Agency Consortium for Trauma-Induced Coagulopathy [UM1 HL120877-06]
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COVID-19 is associated with significant coagulopathy, leading to increased rates of venous and arterial thromboembolic events. Inflammatory response in COVID-19 is linked to coagulopathy, posing challenges for diagnosis, prevention, and treatment of thrombotic complications. Endothelial injury and augmented innate immune response play a role in the development of thrombosis in COVID-19.
There is increasing evidence that novel coronavirus disease 2019 (COVID-19) leads to a significant coagulopathy, a phenomenon termed COVID-19 associated coagulopathy. COVID-19 has been associated with increased rates of both venous and arterial thromboembolic events, a source of significant morbidity and mortality in this disease. Further evidence suggests a link between the inflammatory response and coagulopathy associated with COVID-19. This presents a unique set of challenges for diagnosis, prevention, and treatment of thrombotic complications. In this review, we summarize and discuss the current literature on laboratory coagulation disruptions associated with COVID-19 and the clinical effects of thromboembolic events including pulmonary embolism, deep vein thrombosis, peripheral arterial thrombosis, and acute ischemic stroke in COVID-19. Endothelial injury and augmented innate immune response are implicated in the development of diffuse macro- and microvascular thrombosis in COVID-19. The pathophysiology of COVID-19 associated coagulopathy is an important determinant of appropriate treatment and monitoring of these complications. We highlight the importance of diagnosis and management of dysregulated coagulation in COVID-19 to improve outcomes in COVID-19 patients with thromboembolic complications.
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