Methodological Issues and Controversies in COVID-19 Coagulopathy: A Tale of Two Storms

Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620945398. doi: 10.1177/1076029620945398.


Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in ECMO devices, all in the face of prophylactic and sometimes even therapeutic anti-coagulation, are frequent features of COVID-19 coagulopathy. The trials available to guide clinicians are methodologically limited. There are several unresolved controversies including 1) Should all hospitalized patients with COVID-19 receive prophylactic anti-coagulation? 2) Which patients should have their dosage escalated to intermediate dose? 3) Which patients should be considered for full-dose anti-coagulation even without a measurable thromboembolic event and how should that anti-coagulation be monitored? 4) Should patients receive post-discharge anti-coagulation? 5) What thrombotic issues are related to the various medications being used to treat this coagulopathy? 6) Is anti-phospholipid anti-body part of this syndrome? 7) How do the different treatments for this disease impact the coagulation issues? The aims of this article are to explore these questions and interpret the available data based on the current evidence.

Publication types

  • Review

MeSH terms

  • Anticoagulants / administration & dosage*
  • Blood Coagulation Disorders / diagnosis
  • Blood Coagulation Disorders / drug therapy*
  • Blood Coagulation Disorders / epidemiology*
  • COVID-19
  • Case-Control Studies
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / therapy
  • Dexamethasone / administration & dosage
  • Female
  • Fibrin Fibrinogen Degradation Products / therapeutic use*
  • Humans
  • Male
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / therapy
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Severe Acute Respiratory Syndrome / diagnosis
  • Severe Acute Respiratory Syndrome / epidemiology
  • Survival Analysis
  • Treatment Outcome
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*


  • Anticoagulants
  • Fibrin Fibrinogen Degradation Products
  • Dexamethasone