Increased blood clotting in COVID-19

Coagulation disorder in COVID-19 (Lancet, 10th July)

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In severe COVID cases

Severe acute respiratory syndrome

Severe dyspnoea and hypoxaemia

Sepsis or septic shock

Life-threatening organ dysfunction

Mild, moderate, severe, and critical COVID-19 infection

Increases blood clotting

COVID-19 infection is associated with coagulopathy of varying degrees

Similar to the changes observed in sepsis induced coagulopathy (SIC) or disseminated intravascular coagulopathy (DIC).

Severity of coagulopathy was associated with the severity of COVID-19 and mortality

Coagulopathy is associated with an endotheliopathy that causes a thrombotic microangiopathy and microcirculatory impairment.

Post-mortem findings of microvascular platelet-rich thrombotic depositions in small vessels of the lungs and other organs

Plausible explanation of sudden cerebrovascular complications

Myocardial ischaemia

Increasing reports of both micro-circulatory and macro-circulatory thromboembolic complications

High incidence of VTE in hospitalized COVID‐19 patients

Particularly those with severe illness

Similar to the high VTE rates observed in patients with other viral pneumonias

Including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS‐CoV)

Implications for patient management

Thrombosis prophylaxis

Scientific and Standardization Committee of the International Society on Thrombosis and

Haemostasis

“a change of anticoagulant regimen from prophylactic low molecular weight heparin or intermediate-dose to treatment-dose regimen can be considered in patients without established venous thromboembolism, but deteriorating pulmonary status or acute respiratory distress syndrome”