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Hamostaseologie 2020; 40(03): 264-269
DOI: 10.1055/a-1178-3551
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Coagulopathy in COVID-19 and Its Implication for Safe and Efficacious Thromboprophylaxis

Florian Langer
1   Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
Stefan Kluge
2   Klinik für Intensivmedizin, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
Robert Klamroth
3   Zentrum für Gefäßmedizin, Klinik für Innere Medizin – Angiologie und Hämostaseologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
,
Johannes Oldenburg
4   Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinik Bonn, Bonn, Germany
› Author Affiliations
Further Information

Publication History

13 May 2020

14 May 2020

Publication Date:
04 June 2020 (online)

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Abstract

The novel coronavirus, SARS-CoV-2, is causing a global pandemic of life-threatening multiorgan disease, called COVID-19. Accumulating evidence indicates that patients with COVID-19 are at significant risk of thromboembolic complications, mainly affecting the venous, but also the arterial vascular system. While the risk of venous thromboembolism (VTE) appears to be higher in patients requiring intensive care unit support compared to those admitted to general wards, recent autopsy findings and data on the timing of VTE diagnosis relative to hospitalization clearly suggest that thromboembolic events also contribute to morbidity and mortality in the ambulatory setting. In addition to a severe hypercoagulable state caused by systemic inflammation and viral endotheliitis, some patients with advanced COVID-19 may develop a coagulopathy, which meets established laboratory criteria for disseminated intravascular coagulation, but is not typically associated with relevant bleeding. Similar to other medical societies, the Society of Thrombosis and Haemostasis Research has issued empirical recommendations on initiation, dosing, and duration of pharmacological VTE prophylaxis in COVID-19 patients.

Zusammenfassung

Das neue Coronavirus SARS-CoV-2 ist für eine weltweite Pandemie der lebensbedrohlichen Multiorganerkrankung COVID-19 verantwortlich. Zahlreiche Fallserien und Beobachtungsstudien zeigen, dass betroffene Patienten ein erhebliches Risiko für Thromboembolien aufweisen, die vor allem das venöse, jedoch auch das arterielle Gefäßsystem betreffen. Während das Risiko für eine venöse Thromboembolie (VTE) bei Intensivpatienten höher zu sein scheint als bei Patienten auf der Normalstation, deuten aktuelle Obduktionsbefunde und Analysen des zeitlichen Zusammenhangs zwischen VTE-Diagnose und Krankenhausaufnahme darauf hin, dass Thromboembolien auch im ambulanten Bereich signifikant zur Morbidität und Mortalität beitragen. Zusätzlich zur Hyperkoagulabilität, hervorgerufen durch Entzündung und virale Endotheliitis, entwickeln einige Patienten mit fortgeschrittener Erkrankung eine Koagulopathie, die die Laborkriterien einer disseminierten intravasalen Gerinnung erfüllt, jedoch selten mit einer Blutungsneigung einhergeht. Wie andere Fachgesellschaften hat auch die GTH e.V. empirische Empfehlungen zur Indikationsstellung, Dosierung und Dauer einer medikamentösen VTE-Prophylaxe bei COVID-19 formuliert.

Keywords

COVID-19 - deep vein thrombosis - pulmonary embolism - coagulopathy

Schlüsselwörter

COVID-19 - Beinvenenthrombose - Lungenembolie - Koagulopathie
 

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