Evaluation of the prophylaxis and treatment of COVID-associated coagulopathy

Elbeddini, Ali; Gerochi, Rachel; Elshahawi, Ahmed

Most of the current “literature” surrounding the presence of thrombosis in COVID-19 disease and appropriate prophylaxis/treatment modalities is certainly retrospective at best, and anecdotal at worst. But in these times of rapidly changing information and perspective, an assessment of all available data (including expert opinion) is the goal of this review. Bleeding risk factors for COVID-19-associated bleeding may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. Bleeding risk factors may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. My manuscript presents the risk and evidence around the COVID-19-associated coagulopathies