COVID-19-associated coagulopathy and disseminated intravascular coagulation

Int J Hematol. 2021 Jan;113(1):45-57. doi: 10.1007/s12185-020-03029-y. Epub 2020 Nov 7.


The pathology of coronavirus disease 2019 (COVID-19) is exacerbated by the progression of thrombosis, and disseminated intravascular coagulation (DIC), and cytokine storms. The most frequently reported coagulation/fibrinolytic abnormality in COVID-19 is the increase in D-dimer, and its relationship with prognosis has been discussed. However, limits exist to the utility of evaluation by D-dimer alone. In addition, since the coagulation/fibrinolytic condition sometimes fluctuates within a short period of time, regular examinations in recognition of the significance of the examination are desirable. The pathophysiology of disseminated intravascular coagulation (DIC) associated with COVID-19 is very different from that of septic DIC, and both thrombotic and hemorrhagic pathologies should be noted. COVID-19 thrombosis includes macro- and microthrombosis, with diagnosis of the latter depending on markers of coagulation and fibrinolysis. Treatment of COVID-19 is classified into antiviral treatment, cytokine storm treatment, and thrombosis treatment. Rather than providing uniform treatment, the treatment method most suitable for the severity and stage should be selected. Combination therapy with heparin and nafamostat is expected to develop in the future. Fibrinolytic therapy and adsorption therapy require further study.

Keywords: COVID-19; Cytokine storm; DIC; Disseminated intravascular coagulation; SARS-CoV-2; Thrombosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Benzamidines
  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation Disorders / physiopathology
  • Blood Coagulation Tests
  • COVID-19 / blood*
  • COVID-19 / complications
  • COVID-19 / mortality
  • COVID-19 / therapy
  • COVID-19 Drug Treatment
  • Cytokine Release Syndrome / blood
  • Cytokine Release Syndrome / drug therapy
  • Cytokine Release Syndrome / etiology
  • Disseminated Intravascular Coagulation / etiology
  • Disseminated Intravascular Coagulation / physiopathology
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinolysis
  • Guanidines / pharmacology
  • Guanidines / therapeutic use
  • Humans
  • Lymphopenia / etiology
  • Male
  • Middle Aged
  • Pandemics*
  • Prognosis
  • Pulmonary Circulation
  • SARS-CoV-2* / drug effects
  • Survivors
  • Thrombocytopenia / etiology
  • Thrombophilia / drug therapy
  • Thrombophilia / etiology
  • Thrombophilia / physiopathology


  • Anticoagulants
  • Benzamidines
  • Fibrin Fibrinogen Degradation Products
  • Guanidines
  • fibrin fragment D
  • nafamostat