Coagulopathy accompanying severe forms of coronavirus infection (COVID-19) – incidence of thrombotic complications, how to prevent and treat them

Abstract

COVID-19 coronavirus infection has a number of clinical manifestations. More serious course is accompanied by hypercoagulation status and endothelial damage, with a higher risk of venous thrombotic and thromboembolic complications (VTE). These complications significantly increase the risk of death. The incidence of VTE at COVID-19 differs in subpopulations, could be present in a quarter to a third of hospitalized patients. Conversely, thrombotic events in the arterial bed (myocardial infarction, ischemic stroke or peripheral embolism) occur in about 5% of patients with a serious course. In the pathogenesis of thromboembolic disease many factors are involved – inflammation, i.e. release of a number of prothrombotic acute phase reactants (e.g. C-reactive protein, fibrinogen) and platelet activation, as well as damage of the endothelial lining usual in viral infection and inserted catheters, along with slowing flow during bed rest. In the pathogenesis of myocardial infarction or ischemic strokes associated with SARS-CoV-2 infection, damage of the endothelium and the deeper layers of the artery wall is likely to be dominantly affected. The importance of thrombotic complications on the course and prognosis of coronavirus infection is also evidenced by the large negative significance of the presence of fibrin degradation products, especially D-dimers. The finding that thrombotic complications are common and are involved in impaired prognosis in more complicated patients with COVID-19 logically leads to the inclusion of anticoagulant treatment (specifically with low molecular weight heparins, LMWH) among the basic treatment approaches. In patients without thromboembolic disease evidence, we choose higher prophylactic doses, when suspected VTE or when confirming the diagnosis, a full therapeutic dose of LMWH according to weight is indicated. In patients with outpatient treatment anticoagulant prophylaxis is indicated only with a history of thromboembolic disease or in conditions associated with a higher risk of thrombosis (hormonal treatment, obesity, smoking, chronic venous disease, etc.). Good hydratation, maintaining venous perfusion with exercise, and bandages, along with the restriction of immobility, is the rule in all patients, especially the sick elderly.