COVID-19 Associated Hypercoagulability: Manifestations, Mechanisms, and Management

Shock. 2021 Apr 1;55(4):465-471. doi: 10.1097/SHK.0000000000001660.

Abstract

Patients with severe coronavirus disease-2019 (COVID-19) frequently have hypercoagulability caused by the immune response to the severe acute respiratory syndrome coronavirus-2 infection. The pathophysiology of COVID-19 associated hypercoagulability is not fully understood, but characteristic changes include: increased fibrinogen concentration, increased Factor VIII activity, increased circulating von Willebrand factor, and exhausted fibrinolysis. Anticoagulant therapy improves outcomes in mechanically ventilated patients with COVID-19 and viscoelastic coagulation testing offers an opportunity to tailor anticoagulant therapy based on an individual patient's coagulation status. In this narrative review, we summarize clinical manifestations of COVID-19, mechanisms, monitoring considerations, and anticoagulant therapy. We also review unique considerations for COVID-19 patients who are on extracorporeal membrane oxygenation.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Blood Coagulation Tests
  • Blood Viscosity / physiology
  • COVID-19 / blood
  • COVID-19 / diagnosis*
  • COVID-19 / therapy*
  • Combined Modality Therapy
  • Correlation of Data
  • Endothelium, Vascular / physiopathology
  • Extracorporeal Membrane Oxygenation
  • Factor VIII / physiology
  • Fibrinogen / physiology
  • Fibrinolysis / drug effects
  • Fibrinolysis / physiology
  • Humans
  • Monitoring, Physiologic
  • Respiration, Artificial
  • Thrombelastography
  • Thrombophilia / blood
  • Thrombophilia / diagnosis*
  • Thrombophilia / therapy*

Substances

  • Anticoagulants
  • Factor VIII
  • Fibrinogen