A Review of Pathophysiology, Clinical Features, and Management Options of COVID-19 Associated Coagulopathy

Shock. 2021 Jun 1;55(6):700-716. doi: 10.1097/SHK.0000000000001680.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Blood Coagulation / immunology*
  • Blood Coagulation Disorders* / etiology
  • Blood Coagulation Disorders* / immunology
  • Blood Coagulation Disorders* / pathology
  • Blood Coagulation Disorders* / therapy
  • COVID-19* / complications
  • COVID-19* / pathology
  • COVID-19* / therapy
  • Humans
  • Immunity, Innate*
  • Ischemic Stroke / complications
  • Ischemic Stroke / metabolism
  • Ischemic Stroke / pathology
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / immunology
  • Pulmonary Embolism / pathology
  • Pulmonary Embolism / therapy
  • SARS-CoV-2 / immunology*
  • Thrombosis / etiology
  • Thrombosis / immunology
  • Thrombosis / pathology
  • Thrombosis / therapy