COVID-19–Associated Coagulopathy and Inflammatory Response

What Do We Know Already and What Are the Knowledge Gaps?

Klaus Görlinger, MD; Daniel Dirkmann, MD, PhD; Ajay Gandhi, MD; Paolo Simioni, MD, PhD


Anesth Analg. 2020;131(5):1324-1333. 

In This Article

Abstract and Introduction


Patients with coronavirus disease 2019 (COVID-19) frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6), and immunity (such as lymphocyte count) as well as clinical scoring systems (such as sequential organ failure assessment [SOFA], International Society on Thrombosis and Hemostasis disseminated intravascular coagulation [ISTH DIC], and sepsis-induced coagulopathy [SIC] score) can be helpful in predicting clinical course, need for hospital resources (such as intensive care unit [ICU] beds, intubation and ventilator therapy, and extracorporeal membrane oxygenation [ECMO]) and patient's outcome in patients with COVID-19. However, therapeutic options are actually limited to unspecific supportive therapy. Whether viscoelastic testing can provide additional value in predicting clinical course, need for hospital resources and patient's outcome or in guiding anticoagulation in COVID-19–associated coagulopathy is still incompletely understood and currently under investigation (eg, in the rotational thromboelastometry analysis and standard coagulation tests in hospitalized patients with COVID-19 [ROHOCO] study). This article summarizes what we know already about COVID-19–associated coagulopathy and—perhaps even more importantly—characterizes important knowledge gaps.


After severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002, H1N1 influenza in 2009 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is now challenging the world with coronavirus disease 2019 (COVID-19). Although most of the infected persons either have subclinical or mild clinical symptoms, a small patient population has severe disease manifestations of COVID-19. In particular, this applies for male patients >60 years and patients with comorbidities. Patients with poor outcome are characterized by a high incidence of COVID-19–associated coagulopathy, venous thrombosis, pulmonary embolism (PE)/thrombosis, and multiple organ failure.[1]