COVID-19 pneumonia: the impact of coagulopathy

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.