COVID-19 Associated Hypercoagulability: Manifestations, Mechanisms, and Management
Shock (Augusta, Ga.)
ABSTRACT: 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.
Mazzeffi, M., Chow, J., & Tanaka, K. (2021). COVID-19 Associated Hypercoagulability: Manifestations, Mechanisms, and Management. Shock (Augusta, Ga.), 55 (4). http://dx.doi.org/10.1097/SHK.0000000000001660