Risk Management and Treatment of Coagulation Disorders Related to COVID-19 Infection

Christian Zanza, Fabrizio Racca, Yaroslava Longhitano, Andrea Piccioni, Francesco Franceschi, Marco Artico, Ludovico Abenavoli, Aniello Maiese, Giovanna Passaro, Gianpietro Volonnino and Raffaele La Russa
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Christian Zanza: Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy
Fabrizio Racca: Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
Yaroslava Longhitano: Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
Andrea Piccioni: Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy
Francesco Franceschi: Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy
Marco Artico: Department of Sensory Organs, Sapienza University of Rome Policlinico Umberto I, 00155 Rome, Italy
Ludovico Abenavoli: Department of Health Sciences, Magnae Grecia University of Catanzaro, 88100 Catanzaro, Italy
Aniello Maiese: Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
Giovanna Passaro: Gemelli IRCCS Research Hospital, Fondazione Policlinico Universitario A, 00168 Rome, Italy
Gianpietro Volonnino: Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy
Raffaele La Russa: Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy

IJERPH, 2021, vol. 18, issue 3, 1-16

Abstract: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease. Bilateral pneumonia, acute respiratory failure, systemic inflammation, endothelial dysfunction and coagulation activation are key features of severe COVID-19. Fibrinogen and D-dimer levels are typically increased. The risk for venous thromboembolism is markedly increased, especially in patients in the intensive care unit despite prophylactic dose anticoagulation. Pulmonary microvascular thrombosis has also been described and the risk for arterial thrombotic diseases also appears to be increased while bleeding is less common than thrombosis, but it can occur. Evaluation for venous thromboembolism may be challenging because symptoms of pulmonary embolism overlap with COVID-19, and imaging studies may not be feasible in all cases. The threshold for evaluation or diagnosis of thromboembolism should be low given the high frequency of these events. Management and treatment are new challenges due to the paucity of high-quality evidence regarding efficacy and safety of different approaches to prevent or treat thromboembolic complications of the disease. All inpatients should receive thromboprophylaxis unless contraindicated. Some institutional protocols provide more aggressive anticoagulation with intermediate or even therapeutic dose anticoagulation for COVID-19 patients admitted to ICU. Therapeutic dose anticoagulation is always appropriate to treat deep venous thrombosis or pulmonary embolism, unless contraindicated. This article reviews evaluation and management of coagulation abnormalities in individuals with COVID-19.

Keywords: COVID-19; deep vein thrombosis; pulmonary embolism; coagulopathy; venous thromboembolism; thromboprophylaxis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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