The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management
Open accessAbstract
The 2019 coronavirus disease (COVID-19) presents with a large variety of clinical manifestations ranging from asymptomatic carrier state to severe respiratory distress, multiple organ dysfunction and death. While it was initially considered primarily a respiratory illness, rapidly accumulating data suggests that COVID-19 results in a unique, profoundly prothrombotic milieu leading to both arterial and venous thrombosis. Consistently, elevated D-dimer level has emerged as an independent risk factor for poor outcomes, including death. Several other laboratory markers and blood counts have also been associated with poor prognosis, possibly due to their connection to thrombosis. At present, the pathophysiology underlying the hypercoagulable state is poorly understood. However, a growing body of data suggests that the initial events occur in the lung. A severe inflammatory response, originating in the alveoli, triggers a dysfunctional cascade of inflammatory thrombosis in the pulmonary vasculature, leading to a state of local coagulopathy. This is followed, in patients with more severe disease, by a generalized hypercoagulable state that results in macro- and microvascular thrombosis. Of concern, is the observation that anticoagulation may be inadequate in many circumstances, highlighting the need for alternative or additional therapies. Numerous ongoing studies investigating the pathophysiology of the COVID-19 associated coagulopathy may provide mechanistic insights that can direct appropriate interventional strategies.
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COVID-19 infection can cause a hypercoagulable state leading to thrombotic complications in various systems.
“A COVID-19 infection can cause a hypercoagulable state leading to thrombotic complications in various systems.”
From Outcomes of Acute Mesenteric Ischemia in Patients With COVID-19: A Nationwide Database Study (2023) · cites this paper as [3]
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- Authors
- Abou-Ismail, M. Y., Diamond, A., Kapoor, S., Arafah, Y., & Nayak, L.
- Affiliations
- University Hospitals of Cleveland (US)
- Alaska Native Medical Center (US)
- Corresponding author
- Nayak, Lalitha
- Venue
- Thrombosis Research
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 194
- Pages
- 101-115
- ISSN
- 0049-3848 (ISSN-L)
- PMC
- PMC7305763
- OpenAlex
- W3036625914
- Cited by
- 694
- References
- 140
- Citations by year
- 2026: 14 · 2025: 50 · 2024: 88 · 2023: 109 · 2022: 183 · 2021: 196 · 2020: 54
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-08-01)
- Open access
- bronze
- doi.org
- Locations
- Thrombosis Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Scholarly Commons @ Case Western Reserve University (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL142647-01, HL121131-01, U01 HL143402.)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- COVID-19 pandemic, hypercoagulability, coagulopathy, thrombosis, D-dimer, arterial thrombosis, venous thrombosis, pulmonary thrombosis, anticoagulation, prognostic factors, pathophysiology
- MeSH terms
- COVID-19, COVID-19 Drug Treatment, Animals, Anti-Inflammatory Agents, Anticoagulants, Blood Coagulation, Humans, Inflammation, Thrombosis, Incidence, Thrombophilia, Venous Thromboembolism
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