The coagulopathy, endotheliopathy, and vasculitis of COVID-19

• Published in: Inflammation research Vol. 69; no. 12; pp. 1181 - 1189
• Main Authors: Iba, Toshiaki, Connors, Jean Marie, Levy, Jerrold H.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2020; Springer Nature B.V
• Subjects: Allergology; Alveoli; Anticoagulants; Betacoronavirus; Biomedical and Life Sciences; Biomedicine; Blood Coagulation Disorders - drug therapy; Blood Coagulation Disorders - virology; Coagulation; Complications; Coronaviridae; Coronavirus Infections - complications; Coronavirus Infections - physiopathology; Coronaviruses; COVID-19; Damage; Dermatology; Dimers; Endothelial Cells; Endothelium, Vascular - physiopathology; Fibrin Fibrinogen Degradation Products - analysis; Humans; Immune system; Immunology; Infections; Lung - blood supply; Microvasculature; Microvessels; Neurology; Pandemics; Pharmacology/Toxicology; Pneumocytes; Pneumonia, Viral - complications; Pneumonia, Viral - physiopathology; PubMed; Pulmonary Embolism; Respiratory diseases; Review; Rheumatology; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Thromboembolism; Thrombosis; Thrombosis - virology; Vascular diseases; Vasculitis; Vasculitis - virology; Viral diseases; COVID-19; Vasculitis; Endotheliopathy; Thromboembolism; Coagulopathy
• ISSN: 1023-3830; 1420-908X; 1420-908X
• DOI: 10.1007/s00011-020-01401-6

Background COVID-19-associated coagulopathy (CAC) characterized by the elevated D-dimer without remarkable changes of other global coagulation markers is associated with various thrombotic complications and disease severity. The purpose of this review is to elucidate the pathophysiology of this unique coagulopathy. Methods The authors performed online search of published medical literature through PubMed using the MeSH (Medical Subject Headings) term "COVID-19," "SARS-CoV-2," "coronavirus," "coagulopathy," and "thrombus." Then, selected 51 articles that closely relevant to coagulopathy in COVID-19. Results The primary targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are the pneumocytes, immune cells, and vascular endothelial cells. The alveolar damage and the pulmonary microvascular thrombosis are the major causes of acute lung injury in COVID-19. The endotheliopathy that occurs is due to direct SARS-CoV-2 infection and activation of other pathways that include the immune system and thromboinflammatory responses leading to what is termed CAC. As a result, both microvascular and macrovascular thrombotic events occur in arterial, capillary, venule, and large vein vascular beds to produce multiorgan dysfunction and thrombotic complications. In addition to the endothelial damage, SARS-CoV-2 also can cause vasculitis and presents as a systemic inflammatory vascular disease. Clinical management of COVID-19 includes anticoagulation but novel therapies for endotheliopathy, hypercoagulability, and vasculitis are needed. Conclusion The endotheliopathy due to direct endothelial infection with SARS-COV-2 and the indirect damage caused by inflammation play the predominant role in the development of CAC. The intensive control of thromboinflammation is necessary to improve the outcome of this highly detrimental contagious disease.