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Coagulation Abnormalities in Patients with COVID-19

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Practical Trends in Anesthesia and Intensive Care 2020-2021

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Abstract

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease. Bilateral pneumonia, acute respiratory failure, systemic inflammation, endothelial dysfunction, and coagulation activation have been described as key features of severe COVID-19.

Fibrinogen and D-dimer are typically increased. Moreover, the risk for venous thromboembolism is markedly increased, especially in patients in the intensive care unit, often despite prophylactic-dose anticoagulation. Pulmonary microvascular thrombosis has also been described and the risk for arterial thrombotic diseases also appears to be increased. Bleeding is less common than thrombosis but 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. All inpatients should receive thromboprophylaxis unless contraindicated. In hospitalized patients with COVID-19, prophylactic dosing rather than more intensive (intermediate or therapeutic) dosing are suggested. On the other hand, therapeutic dose of 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.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Fabrizio Racca, Christian Zanza & Yaroslava Longhitano

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  1. Fabrizio Racca
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  2. Christian Zanza
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  3. Yaroslava Longhitano
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Correspondence to Fabrizio Racca .

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  1. SC Anestesia e Rianimazione, Ospedale San Paolo, Milan, Italy

    Davide Chiumello

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Racca, F., Zanza, C., Longhitano, Y. (2022). Coagulation Abnormalities in Patients with COVID-19. In: Chiumello, D. (eds) Practical Trends in Anesthesia and Intensive Care 2020-2021. Springer, Cham. https://doi.org/10.1007/978-3-031-14612-1_8

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