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Complement activation and coagulopathy - an ominous duo in COVID19.
Tomo, Sojit; Kumar, Kiran Pvsn; Roy, Dipayan; Sankanagoudar, Shrimanjunath; Purohit, Purvi; Yadav, Dharamveer; Banerjee, Mithu; Sharma, Praveen; Misra, Sanjeev.
  • Tomo S; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Kumar KP; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Roy D; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Sankanagoudar S; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Purohit P; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Yadav D; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Banerjee M; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Sharma P; Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India.
  • Misra S; Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Expert Rev Hematol ; 14(2): 155-173, 2021 02.
Article in English | MEDLINE | ID: covidwho-1044433
ABSTRACT

INTRODUCTION:

COVID-19 has similarities to the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks, as severe patients and non-survivors have frequently shown abnormal coagulation profiles. Immune-mediated pathology is a key player in this disease; hence, the role of the complement system needs assessment. The complement system and the coagulation cascade share an intricate network, where multiple mediators maintain a balance between both pathways. Coagulopathy in COVID-19, showing mixed features of complement-mediated and consumption coagulopathy, creates a dilemma in diagnosis and management. AREAS COVERED Pathophysiology of coagulopathy in COVID-19 patients, with a particular focus on D-dimer and its role in predicting the severity of COVID-19 has been discussed. A comprehensive search of the medical literature on PubMed was done till May 30th, 2020 with the keywords 'COVID-19', 'SARS-CoV-2', 'Coronavirus', 'Coagulopathy', and 'D-dimer'. Twenty-two studies were taken for weighted pooled analysis of D-dimer. EXPERT OPINION A tailored anticoagulant regimen, including intensification of standard prophylactic regimens with low-molecular-weight heparin is advisable for COVID-19 patients. Atypical manifestations and varying D-dimer levels seen in different populations bring forth the futility of uniform recommendations for anticoagulant therapy. Further, direct thrombin inhibitors and platelet inhibitors in a patient-specific manner should also be considered.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Coagulation Disorders / Complement Activation / SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study / Reviews Topics: Long Covid Country/Region as subject: Asia Language: English Journal: Expert Rev Hematol Journal subject: Hematology Year: 2021 Document Type: Article Affiliation country: 17474086.2021.1875813

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Coagulation Disorders / Complement Activation / SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study / Reviews Topics: Long Covid Country/Region as subject: Asia Language: English Journal: Expert Rev Hematol Journal subject: Hematology Year: 2021 Document Type: Article Affiliation country: 17474086.2021.1875813