Key result
COVID-19 coagulopathy drives frequent thrombotic complications, with pulmonary embolism rates reaching ~40%.
Why the study?
COVID-19 is associated with increased venous and arterial thromboembolic events linked to an inflammatory response, presenting unique challenges for the diagnosis, prevention, and treatment of thrombotic complications.
Systematic Review
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This systematic review synthesizes the pathophysiological link between thromboinflammation, endothelial injury, and hypercoagulability in COVID-19, highlighting that COVID-19 coagulopathy is distinct from overt DIC and requires vigilant laboratory monitoring and thromboprophylaxis.
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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Goswami et al. (2020) conducted a systematic review in COVID-19 associated coagulopathy. COVID-19 infection and associated coagulopathy was evaluated on Venous and arterial thromboembolic events (PE, DVT, acute ischemic stroke, peripheral arterial thrombosis) and laboratory coagulation disruptions. COVID-19 associated coagulopathy is characterized by elevated D-dimer, endothelial injury, and thromboinflammation, resulting in pulmonary embolism rates of 5.9%-40% and DVT rates of 6%-46%.
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