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.
【저자키워드】 COVID-19, Venous Thromboembolism, Coagulopathy, Pulmonary embolism, Deep vein thrombosis, Thromboprophylaxis, 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, Respiratory failure, anticoagulation, thrombosis, intensive care, severe COVID-19, Pneumonia, intensive care unit, Diagnosis, Acute respiratory failure, risk, Symptom, Infectious disease, pulmonary, Venous Thromboembolism, Endothelial dysfunction, Coagulation, Pulmonary embolism, management, therapeutic, Patient, Thromboembolism, Venous thrombosis, bleeding, Emerging infectious disease, fibrinogen, Efficacy and safety, systemic inflammation, Deep venous thrombosis, threshold, disease, Thromboprophylaxis, Evidence, D-dimer level, Frequency, dose, COVID-19 patient, therapeutic dose, prophylactic dose, Inpatient, Microvascular thrombosis, thromboembolic, Activation, D-dimer levels, overlap, thrombotic, treat, bilateral pneumonia, institutional protocol, thromboembolic complications, abnormality, approach, Prevent, feature, described, the disease, events, appear, less, occur, feasible, receive, admitted to ICU, Bilateral, individuals with COVID-19, thromboembolic complication, with COVID-19,