Open AccessCOVID-19 Associated Hypercoagulability: Manifestations, Mechanisms, and Management
Author(s) -
Michael Mazzeffi,
Jonathan H. Chow,
Kenichi A. Tanaka
Publication year - 2020
Publication title -
shock
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.095
H-Index - 117
eISSN - 1540-0514
pISSN - 1073-2322
DOI - 10.1097/shk.0000000000001660
Subject(s) - medicine , fibrinolysis , coagulation , extracorporeal membrane oxygenation , fibrinogen , coagulopathy , covid-19 , transfusion therapy , coronavirus , von willebrand factor , intensive care medicine , immunology , disease , platelet , blood transfusion , infectious disease (medical specialty)
Patients with severe coronavirus disease-2019 (COVID-19) frequently have hypercoagulability caused by the immune response to the severe acute respiratory syndrome coronavirus-2 infection. The pathophysiology of COVID-19 associated hypercoagulability is not fully understood, but characteristic changes include: increased fibrinogen concentration, increased Factor VIII activity, increased circulating von Willebrand factor, and exhausted fibrinolysis. Anticoagulant therapy improves outcomes in mechanically ventilated patients with COVID-19 and viscoelastic coagulation testing offers an opportunity to tailor anticoagulant therapy based on an individual patient's coagulation status. In this narrative review, we summarize clinical manifestations of COVID-19, mechanisms, monitoring considerations, and anticoagulant therapy. We also review unique considerations for COVID-19 patients who are on extracorporeal membrane oxygenation.