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World J Methodol. Sep 20, 2022; 12(5): 331-349
Published online Sep 20, 2022. doi: 10.5662/wjm.v12.i5.331
Hemostatic system and COVID-19 crosstalk: A review of the available evidence
Mohamed-Naguib Wifi, Mohamed Abdelkader Morad, Reem El Sheemy, Nermeen Abdeen, Shimaa Afify, Mohammad Abdalgaber, Abeer Abdellatef, Mariam Zaghloul, Mohamed Alboraie, Mohamed El-Kassas
Mohamed-Naguib Wifi, Abeer Abdellatef, Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
Mohamed Abdelkader Morad, Clinical Hematology Unit, Department of Internal Medicine, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
Reem El Sheemy, Department of Tropical Medicine, Minia Faculty of Medicine, Minia University, Minia 61511, Egypt
Nermeen Abdeen, Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria 21523, Egypt
Shimaa Afify, Department of Gastroenterology, National Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo 11451, Egypt
Mohammad Abdalgaber, Department of Gastroenterology and Hepatology, Police Authority Hospital, Agoza, Giza 12511, Egypt
Mariam Zaghloul, Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh 33511, Egypt
Mohamed Alboraie, Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
Mohamed El-Kassas, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan 11731, Egypt
Author contributions: Morad MA, El Sheemy R, Abdeen N, Afify S, Abdalgaber M, Abdellatef A, and Zaghloul M contributed equally to the original writing of the manuscript; Wifi MN and El-Kassas M contributed equally to reading and revising the subsequent versions of the manuscript; Alboraie M contributed to revisions and provided approval of the final manuscript; All authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed Alboraie, MD, FRCP, Lecturer, Department of Internal Medicine, Al-Azhar University, 1-Alshaheed Street, Nasr City, Cairo 11884, Egypt. alboraie@azhar.edu.eg
Received: December 5, 2021
Peer-review started: December 5, 2021
First decision: January 25, 2022
Revised: March 17, 2022
Accepted: July 19, 2022
Article in press: July 19, 2022
Published online: September 20, 2022
Processing time: 284 Days and 12.7 Hours
Abstract

Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant coronavirus disease 2019 (COVID-19) pandemic, respiratory manifestations have been the mainstay of clinical diagnosis, laboratory evaluations, and radiological investigations. As time passed, other pathological aspects of SARS-CoV-2 have been revealed. Various hemostatic abnormalities have been reported since the rise of the pandemic, which was sometimes superficial, transient, or fatal. Mild thrombocytopenia, thrombocytosis, venous, arterial thromboembolism, and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19. Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19, especially in patients admitted to intensive care units. Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation. Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood, professional societies recommend prophylactic antithrombotic therapy in severe cases, especially in the presence of abnormal coagulation indices. The review article discusses the various available evidence on coagulation disorders, management strategies, outcomes, and prognosis associated with COVID-19 coagulopathy, which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.

Keywords: SARS-CoV-2; COVID-19; Thrombosis; Pulmonary embolism; Disseminated intravascular coagulation

Core Tip: The pathogenesis of hypercoagulable state and thrombosis related to coronavirus disease 2019 (COVID-19) is unclear. Evidence on endothelial cell injury by direct infection of severe acute respiratory syndrome coronavirus 2 is increasing. Histologic and immunohistochemistry examination of lung autopsies and/or the skin of patients who have died of severe COVID-19 has shown microvascular injury and thrombosis, consistent with intensive and generalized activation of both alternative and lectin-based pathways of complement.