SPECIAL ARTICLE   Free access

Acta Phlebologica 2020 August;21(1-2):6-8

DOI: 10.23736/S1593-232X.20.00462-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

COVID-19 pneumonia: the impact of coagulopathy

Luca COSTANZO ¹ ✉, Giacomo FAILLA ¹, Simona A. GRASSO ², Francesco P. PALUMBO ³, Giorgio ARDITA ¹, Luigi DI PINO ⁴, Francesco MUGNO ¹, Paolo FINOCCHIARO ¹, Leonardo ALUIGI ⁵, Pier Luigi ANTIGNANI ⁶

¹ Angiology Unit, San Marco Hospital, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy; ² Department of Anesthesia and Intensive Care, AOU Policlinico-Vittorio Emanuele, Catania, Italy; ³ Surgery Unit, Villa Fiorita Clinic, Prato, Italy; ⁴ Unit of Cardiology and Angiology, Department of Cardiovascular Disease, Centro Alte Specialità e Trapianti (CAST), AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy; ⁵ Department of Angiology, Villalba Clinic, Bologna, Italy; ⁶ Vascular Center, Nuova Villa Claudia, Rome, Italy

The development of coagulopathy is emerging as one of the most significant poor prognostic features in COVID-19 pneumopathy. D-dimer, a protein product of fibrin degradation, has been found elevated in the most severe cases and correlated to mortality. Potentially involved factors in the impairment of coagulation caused by viral infection include the dysregulated inflammatory response, platelet and endothelial dysfunction with impaired fibrinolysis. Autoptic analysis in deaths fore severe COVID-19 disease revealed fibrin exudation in alveoli, blood vessel wall edema and hyaline thrombi in small vessels in other organs and tissues. Heparin is an anticoagulant molecule that also showed anti-inflammatory properties and a potential antiviral effect. The use of low molecular weight heparin could prevent thromboembolic complications in COVID-19 pneumopathy. However, the correct timing of prophylaxis according to the stage of COVID-19 disease and the appropriate therapeutic dosage to use in severe cases need further research.

KEY WORDS: COVID-19; Coronavirus; Thrombosis; Blood coagulation disorders; Fibrin fragment D; Low-molecular-weight heparin