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The coagulopathy, endotheliopathy, and vasculitis of COVID-19.

Publication ,  Journal Article
Iba, T; Connors, JM; Levy, JH
Published in: Inflamm Res
December 2020

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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Published In

Inflamm Res

DOI

EISSN

1420-908X

Publication Date

December 2020

Volume

69

Issue

12

Start / End Page

1181 / 1189

Location

Switzerland

Related Subject Headings

  • Vasculitis
  • Thrombosis
  • SARS-CoV-2
  • Pulmonary Embolism
  • PubMed
  • Pneumonia, Viral
  • Pandemics
  • Microvessels
  • Lung
  • Immunology
 

Citation

APA
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ICMJE
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Iba, T., Connors, J. M., & Levy, J. H. (2020). The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res, 69(12), 1181–1189. https://doi.org/10.1007/s00011-020-01401-6
Iba, Toshiaki, Jean Marie Connors, and Jerrold H. Levy. “The coagulopathy, endotheliopathy, and vasculitis of COVID-19.Inflamm Res 69, no. 12 (December 2020): 1181–89. https://doi.org/10.1007/s00011-020-01401-6.
Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 2020 Dec;69(12):1181–9.
Iba, Toshiaki, et al. “The coagulopathy, endotheliopathy, and vasculitis of COVID-19.Inflamm Res, vol. 69, no. 12, Dec. 2020, pp. 1181–89. Pubmed, doi:10.1007/s00011-020-01401-6.
Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 2020 Dec;69(12):1181–1189.
Journal cover image

Published In

Inflamm Res

DOI

EISSN

1420-908X

Publication Date

December 2020

Volume

69

Issue

12

Start / End Page

1181 / 1189

Location

Switzerland

Related Subject Headings

  • Vasculitis
  • Thrombosis
  • SARS-CoV-2
  • Pulmonary Embolism
  • PubMed
  • Pneumonia, Viral
  • Pandemics
  • Microvessels
  • Lung
  • Immunology