Are patients with coronavirus disease 2019 (COVID-19) at risk for hypercoagulability?

Updated: Jun 16, 2020
  • Author: Medscape Drugs & Diseases; more...
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Some patients with coronavirus 2019 (COVID-19) may develop signs of a hypercoagulable state and be at increased risk for venous and arterial thrombosis of large and small vessels. [1] The pathogenesis for COVID-19-associated hypercoagulability remains unknown. However, hypoxia and systemic inflammation secondary to COVID-19 may lead to high levels of inflammatory cytokines and activation of the coagulation pathway.

Common laboratory abnormalities associated with COVID-19 coagulopathy among hospitalized patients include the following [1] :

  • Mild thrombocytopenia

  • Elevated D-dimer levels, which have been strongly associated with greater risk of death

  • Increased fibrin degradation products

  • Prolonged prothrombin time

The most frequently reported thrombotic complications in hospitalized patients are deep venous thrombosis and pulmonary embolism. [1] Others include the following:

  • Microvascular thrombosis of the toes

  • Clotting of catheters

  • Myocardial injury with ST-segment elevation

  • Large vessel strokes

Limited data are available to inform clinical management around prophylaxis or treatment of venous thromboembolism in COVID-19 patients.

Several national professional associations provide resources for up-to-date information concerning COVID-19-associated hypercoagulability, including management of anticoagulation. This is a rapidly evolving topic, with new information released often.

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