Coagulopathy in SARS-CoV-2 (COVID-19) virus infection: From pathophysiological mechanisms to diagnosis and treatment

The presence of coagulopathy in patients with COVID-19 infection is associated with an increased risk of death. Furthermore, the relevance of these coagulation abnormalities has become a determining factor in the outcome of the sickest patients, as a substantial proportion of patients with severe clinical manifestations develop venous and arterial thromboembolic complications. These are often undiagnosed until post-mortem findings. Available evidence arising from clinical observations and autopsy reports distinguishes COVID-19-associated coagulopathy from thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC). Possible overlaps can be observed in critically ill patients, in whom circulatory collapse, multisystem organ failure, refractory hypoxaemia, and ARDS cause a combination of low-grade DIC and localised thrombotic pulmonary microangiopathy. These could have a substantial impact on organ dysfunction, in the most severely affected patients.