Ana Luísa Batista Pena, Rafael Arantes Oliveira, Renata Gomes Severo and Ana Cristina Simões e Silva* Pages 4207 - 4225 ( 19 )
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has been a global challenge. The complicated forms of the Coronavirus Disease 2019 (COVID- 19) can evolve to multiple-organ failure, including several coagulopathies related to a sudden worsening of respiratory status. This article aimed to review studies about hematological and hemostatic laboratory disorders directly related to COVID-19 and to discuss how SARS-CoV- 2 causes these abnormalities. The coagulation cascade model is associated with both COVID- 19 and pulmonary involvement. Laboratory changes are relevant to evaluate the coagulation state - D-dimer, prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), platelet count and fibrinogen. Pregnant women and patients in Extracorporeal Membrane Oxygenation (ECMO) need special attention. Prophylactic interventions for COVID-19 coagulopathy should consider patients at risk for thrombotic events and potential contraindications. The mechanisms exerted by SARS-CoV-2 that impairs hemostatic balance include endothelial injury, inflammation, and activation of the immune and complement systems. For diagnosis of coagulopathy, mainly D-dimer, but also PT, APTT and FDP, should be evaluated in COVID-19 patients. Intervention possibilities vary between low-molecular-weight heparin (LMWH) and Unfractionated Heparin (UFH). Until now, there is sufficient evidence that acutely-ill patients with risk factors for coagulopathies will benefit from thrombophylaxis during hospitalization and post-discharge, but not all patients.
COVID-19, Coagulation, Coagulopathy, Acute respiratory distress syndrome, Angiotensin-converting enzyme 2, SARS-CoV-2.
Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais