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Inflammation Research

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01-12-2020 | Vasculitis | Review

The coagulopathy, endotheliopathy, and vasculitis of COVID-19

Authors: Toshiaki Iba, Jean Marie Connors, Jerrold H. Levy

Published in: Inflammation Research | Issue 12/2020

Abstract

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.

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Title: The coagulopathy, endotheliopathy, and vasculitis of COVID-19
Authors: Toshiaki Iba
Jean Marie Connors
Jerrold H. Levy
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Vasculitis
Vasculitis
SARS-CoV-2
COVID-19
Hemophagocytic Lymphohistiocytosis
Thrombosis
Hemophagocytic Lymphohistiocytosis
Published in: Inflammation Research / Issue 12/2020
Print ISSN: 1023-3830
Electronic ISSN: 1420-908X
DOI: https://doi.org/10.1007/s00011-020-01401-6

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