COVID-19 and the Coagulation System

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In humans, SARS-CoV-2 primarily infects the cells of the airway that lined the alveoli. The glycoproteins contained in the envelope spike of the virus will bind to the cellular receptor, named ACE2. Cytokine storm due to uncontrolled systemic inflammatory response causes a variety of dangerous complications involving other organ systems, including the hemostasis system. Cytokine storms initiate the activation of the coagulation mechanism caused by clotting factors signal one another to initiate rapid chain reactions (coagulation cascades) and eventually the thrombotic phenomena also occur. Laboratory signs that can be found include prolonged prothrombin time and increases of D-Dimer levels. Coagulopathy in COVID-19 patients is often overlooked due to its invisible disease process and complex diagnostic criteria. Thus, giving anticoagulants to COVID-19 patients can help to reduce the mortality due to complications of hemostasis.