Background: Coronavirus disease-2019 (COVID-19) is a viral respiratory infection caused by the severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2) that may be associated with serious thrombotic complications. These complications may contribute to morbidity and mortality in COVID-19 patients.

Aims: This review aimed at synthesizing evidence that point to haemostatic dysfunctions as essential pathologic components of SARS‐CoV‐2 infection, their prognostic relevance and the antithrombotic management of symptomatic COVID-19 infection.

Methods: The PUBMED, MEDLINE and Cochrane Database of systematic reviews were searched for relevant English-based studies for current best evidence regarding haemostatic findings and complications in symptomatic and asymptomatic COVID-19 patients. Studies were eligible for inclusion if they were meta‐analyses, systematic reviews, observational studies and case-series. Articles were screened and the references were searched to identify additional studies.

Results: Our search yielded 112 potentially eligible studies including two meta-analysis studies (N=2120) and nine systematic reviews. Remainder being observational studies and case series. Thrombocytopenia and elevated D-dimer levels were the most common haemostatic abnormalities seen in moderate to severely symptomatic patients. High D-dimer levels were significantly associated with increased requirement for mechanical ventilation, ICU admission and mortality (P<0.05). There were variations in individual studies regarding association between disease severity and other haemostatic findings including prolonged prothrombin-time, INR, thrombin-time and shortened APTT. Vascular platelet-fibrin clots were commonly reported abnormal haemostatic findings in COVID-19-related-autopsies. There were variations in individual studies with respect to antithrombotic treatment protocols, dosing, and additional interventions. Parenteral anticoagulation was recommended in most cases with known thrombotic disease. Anticoagulation was frequently needed to maintain circuit patency in patients having extracorporeal membrane oxygenation.

Conclusions: Thrombotic episodes may be precedent factors or incident complications in COVID-19 patients. There is weak recommendation but moderate quality evidence regarding preventive and therapeutic use of antithrombotic-agents in COVID-19, hence need for high-quality studies evaluating patient-important clinical outcomes is hereby emphasized

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/haemostatic-dysfunctions-in-covid-19-infection-a-systematic-review/