Coagulation Dynamics in COVID-19 Patients
Summary
The coagulatory system in patients with COVID-19 is characterised by a distinctive and dynamic interplay between procoagulant and fibrinolytic pathways. Infection of endothelial cells by SARS-CoV-2 precipitates widespread endothelial dysfunction, leading to platelet activation, thrombin generation and pulmonary microthrombosis. Laboratory findings commonly include elevated D-dimers and fibrinogen levels alongside minimal early changes in clotting times and platelet count. As the disease progresses, a hypofibrinolytic state may develop, driven by increased levels of plasminogen activator inhibitor-1, further tipping the balance towards thrombosis. This coagulopathy is associated with venous and arterial thromboembolism, acute respiratory distress syndrome and multi-organ impairment, contributing substantially to morbidity and mortality worldwide. Understanding these haemostatic disturbances has guided prophylactic anticoagulation strategies and underpins ongoing efforts to refine personalised therapeutic approaches.
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Coagulation Dynamics in COVID-19 Patients publication trend
The graph below shows the total number of articles in coagulation dynamics in covid-19 patients across all publications each year (not limited to Nature Index journals).
Technical terms
Coagulopathy: A pathological state in which the blood’s ability to form clots is impaired or dysregulated, often leading to excessive bleeding or thrombosis.
Fibrinolysis: The enzymatic process that dissolves fibrin clots, primarily mediated by plasmin after its activation from plasminogen.
D-dimer: A fibrin degradation product present in the blood following clot breakdown; elevated levels indicate increased clot formation and lysis.
Endotheliopathy: Dysfunction or injury of the vascular endothelium, resulting in impaired barrier function, altered antithrombotic properties and promotion of inflammation.
References
- COVID–19-associated coagulopathy: An exploration of mechanisms. Vascular Medicine (2020).
- The unique characteristics of COVID-19 coagulopathy. Critical Care (2020).
- Urokinase-type plasminogen activator and plasminogen activator inhibitor-1 complex as a serum biomarker for COVID-19. Frontiers in Immunology (2024).
- Fibrinolytic abnormalities in acute respiratory distress syndrome (ARDS) and versatility of thrombolytic drugs to treat COVID‐19. Journal of Thrombosis and Haemostasis (2020).
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