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COVID-19–associated coagulopathy (CAC) is a clinical syndrome defined by thrombosis, multisystem organ failure, and death. The authors of this review of CAC outline what is understood about the pathogenesis of intravascular coagulation and recommended monitoring parameters, and highlight the current anticoagulation guidelines.
The pathogenesis of CAC is complex due to the interplay across multiple pathways. Prophylactic anticoagulation according to local guidelines is vital until further evidence is available.
– Kolene E. Bailey, MD
This abstract is available on the publisher's site.
COVID-19-associated coagulopathy (CAC) is a feature of COVID-19 that can lead to various thrombotic complications and death. In this review, we briefly highlight possible etiologies, including direct cytotoxicity caused by the SARS-CoV-2 virus, and the activation of proinflammatory molecules such as cytokines, underlying coagulopathy. Endothelial dysfunction has been highlighted as pivotal, irrespective of the mechanism involved in CAC. Specific features of CAC distinguishing it from disseminated intravascular coagulopathy and sepsis or ARDS-associated coagulopathy have been discussed. We have also highlighted some hematological parameters, such as elevated d-dimers and partial prothrombin and prothrombin times prolongation, which can guide the use of anticoagulation in critically ill patients. We conclude by highlighting the importance of prophylactic anticoagulation in all COVID-19 hospitalized patients and reiterate the need for institution-specific guidelines for anticoagulation COVID-19 patients since individual institutions have different patient populations.