Summary
Background. Studies show that COVID-19 causes damage not only to the lungs but also to other systems, especially to the vascular system, which one of the most serious complication and common cause of death is thromboembolism. Venous thromboembolism is observed in 2/3 thirds of patients treated in the COVID-19 intensive care unit, even when prophylactic anticoagulant doses are used. COVID-19 induced coagulopathy is associated with immunothrombosis, endothelial damage, and atypical inflammatory response.
The aim of the study. The aim of this article is to review the pathophysiology, clinical and diagnostic features of COVID-19 associated coagulopathy, compare COVID-19-associated coagulopathy with other coagulopathies and provide treatment recommendations for COVID-19 associated coagulopathy.
Materials and methods. Articles were searched in the Pubmed and Google scholar using keywords: “COVID-19 associated coagulopathy”. Selected freely available articles published in English in 2020–2021 y. period, which analyzed the pathogenesis, laboratory parameters, risk of thromboembolism, and treatment of COVID-19 associated coagulopathy.
Conclusions. Endotheliopathy, due to direct endothelial SARS-CoV-2 infection, and atypical systemic inflammation are two primary causes of COVID-19 associated coagulopathy. Most common laboratory findings of patients with COVID-19 associated coagulopathy are: high levels of D-dimer and fibrinogen concentration, mild trombocytopenia, mild prolongation of prothrombin time and activated partial thromboplastin time. D-dimer concentrations were found to be directly proportional to the severity of COVID-19 coagulopathy and therefore, it is recommended that D-dimer levels be determined in all patients with COVID-19. If moderately ill hospitalized COVID-19 patients have D-dimer levels > 5 times above the upper limit of normal, even in the absence of signs of thrombosis or thromboembolism, therapeutic doses of low molecular weight heparin should be considered. However, there are in sufficient data on the use of anticoagulation with therapeutic doses in critically severe patients with out clear signs of thromboembolic complications and therefore, the indications should be considered on an individual basis with regard to deterioration of health or risk factors.
