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COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation.
Miesbach, Wolfgang; Makris, Michael.
  • Miesbach W; Department of Haemostaseology and Hemophilia Center, Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Germany.
  • Makris M; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom.
Clin Appl Thromb Hemost ; 26: 1076029620938149, 2020.
Article in English | MEDLINE | ID: covidwho-651515
ABSTRACT
The novel coronavirus infection (COVID-19) is caused by the new coronavirus SARS-CoV-2 and is characterized by an exaggerated inflammatory response that can lead to severe manifestations such as adult respiratory syndrome, sepsis, coagulopathy, and death in a proportion of patients. Among other factors and direct viral effects, the increase in the vasoconstrictor angiotensin II, the decrease in the vasodilator angiotensin, and the sepsis-induced release of cytokines can trigger a coagulopathy in COVID-19. A coagulopathy has been reported in up to 50% of patients with severe COVID-19 manifestations. An increase in d-dimer is the most significant change in coagulation parameters in severe COVID-19 patients, and progressively increasing values can be used as a prognostic parameter indicating a worse outcome. Limited data suggest a high incidence of deep vein thrombosis and pulmonary embolism in up to 40% of patients, despite the use of a standard dose of low-molecular-weight heparin (LMWH) in most cases. In addition, pulmonary microvascular thrombosis has been reported and may play a role in progressive lung failure. Prophylactic LMWH has been recommended by the International Society on Thrombosis and Haemostasis (ISTH) and the American Society of Hematology (ASH), but the best effective dosage is uncertain. Adapted to the individual risk of thrombosis and the d-dimer value, higher doses can be considered, especially since bleeding events in COVID-19 are rare. Besides the anticoagulant effect of LMWH, nonanticoagulant properties such as the reduction in interleukin 6 release have been shown to improve the complex picture of coagulopathy in patients with COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Thrombosis / Coronavirus Infections / Thrombophilia / Pandemics / Betacoronavirus / Anticoagulants Type of study: Observational study / Prognostic study Topics: Long Covid Language: English Journal: Clin Appl Thromb Hemost Journal subject: Vascular Diseases Year: 2020 Document Type: Article Affiliation country: 1076029620938149

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Thrombosis / Coronavirus Infections / Thrombophilia / Pandemics / Betacoronavirus / Anticoagulants Type of study: Observational study / Prognostic study Topics: Long Covid Language: English Journal: Clin Appl Thromb Hemost Journal subject: Vascular Diseases Year: 2020 Document Type: Article Affiliation country: 1076029620938149