COVID‐19‐related coagulopathy: A review of pathophysiology and pharmaceutical management

Kohansal Vajari, Mahdi; Shirin, Mahsa; Pourbagheri‐Sigaroodi, Atieh; Akbari, Mohammad Esmaeil; Abolghasemi, Hassan; Bashash, Davood

December 2019 will never be forgotten in the history of medicine when an outbreak of pneumonia of unknown etiology in Wuhan, China sooner or later prompted the World Health Organization to issue a public health warning emergency. This is not the first nor will it be the last time that a member of β‐coronaviruses (CoVs) is waging a full‐scale war against human health. Notwithstanding the fact that pneumonia is the primary symptom of the novel coronavirus (2019nCoV; designated as SARS‐CoV‐2), the emergence of severe disease mainly due to the injury of nonpulmonary organs at the shadow of coagulopathy leaves no choice, in some cases, rather than a dreadful death. Multiple casual factors such as inflammation, endothelial dysfunction, platelet and complement activation, renin‐angiotensin‐aldosterone system derangement, and hypoxemia play a major role in the pathogenesis of coagulopathy in coronavirus disease 2019 (COVID‐19) patients. Due to the undeniable role of coagulation dysfunction in the initiation of several complications, assessment of coagulation parameters and the platelet count would be beneficial in early diagnosis and also timely prediction of disease severity. Although low‐molecular‐weight heparin is considered as the first‐line of treatment in COVID‐19‐associated coagulopathy, several possible therapeutic options have also been proposed for better management of the disease. In conclusion, this review would help us to gain insight into the pathogenesis, clinical manifestation, and laboratory findings associated with COVID‐19 coagulopathy and would summarize management strategies to alleviate coagulopathy‐related complications.