Current Overview on Hypercoagulability in COVID-19
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LEADING ARTICLE
Current Overview on Hypercoagulability in COVID‑19 Namrata Singhania1 · Saurabh Bansal2 · Divya P. Nimmatoori3 · Abutaleb A. Ejaz4 · Peter A. McCullough5,6,7,8 · Girish Singhania9,10
© Springer Nature Switzerland AG 2020
Abstract The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has brought many unique pathologies, such as coagulopathy, prompting a desperate need for effective management. COVID-19-associated coagulopathy (CAC) can cause various thromboembolic complications, especially in critically ill patients. The pathogenesis is likely due to endothelial injury, immobilization, and an increase in circulating prothrombotic factors. Data on treatment are limited, although prophylactic anticoagulation is advised in all hospitalized patients. Herein, we have comprehensively reviewed the current literature available on CAC and highlight the pathogenesis, clinical features, and management of CAC.
Key Messages Venous thromboembolism (VTE) is common in COVID19 patients, especially those in the intensive care unit. Prophylactic anticoagulation is recommended in all patients with COVID-19 unless contraindicated. * Namrata Singhania [email protected] 1
Department of Hospital Medicine, Mount Carmel East Hospital, 6001 E Broad Street, Columbus, OH 43213, USA
2
Department of Internal Medicine, University of Illinois at Peoria, Peoria, IL 61637, USA
3
Department of Internal Medicine, Greenfield Health, Portland, OR, USA
4
Department of Internal Medicine, University of Florida, Gainesville, FL, USA
5
Department of Cardiovascular Medicine, Baylor Heart and Vascular Institute, Dallas, TX, USA
6
Department of Internal Medicine, Texas A&M College of Medicine Health Science Center, Dallas, TX, USA
7
Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA
8
Department of Cardiovascular Medicine, Baylor Heart and Vascular Hospital, Dallas, TX, USA
9
Department of Hospital Medicine, CHI St Vincent Infirmary, Little Rock, AR, USA
10
Department of Nephrology and Hypertension, University of Utah, Salt Lake City, UT, USA
1 Introduction A novel coronavirus was first identified in late 2019 in Wuhan, China, and rapidly spread throughout the world, causing a pandemic [1]. The virus was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the World Health Organization designated the disease as coronavirus disease 2019 (COVID-19). The most common symptoms are respiratory, but gastrointestinal, neurological, and other atypical symptoms can also be seen, although these symptoms are rare [2]. Recent studies showed several coagulation abnormalities in patients with COVID-19, raising questions about appropriate management to prevent or treat thrombosis; this state has been termed COVID-19-associated coagulopathy (CAC) [3]. The International Society on Thrombosis and Hemostasis (ISTH), the American Society of Hematology (ASH), and the American College of Cardiology (ACC) have
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