Hemostatic abnormalities in COVID-19: A guided review

Abstract The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 213 countries in a matter of weeks. In this context, several studies correlating hemostatic disorders with the infection dynamics of the new coronavirus have emerged. These studies have shown that a portion of the patients affected by Coronavirus Disease 2019 (COVID-19) have prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT), elevated D-dimer levels and other fibrinolytic products, antithrombin (AT) activity reduced and decrease of platelet count. Based on these hallmarks, this review proposes to present possible pathophysiological mechanisms involved in the hemostatic changes observed in the pathological progression of COVID-19. In this analysis, it is pointed the relationship between the downregulation of angiotensin-converting enzyme 2 (ACE2) and storm cytokines action with the onset of hypercoagulability state, other than the clinical events involved in thrombocytopenia and hyperfibrinolysis progression.

摘要 严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2，SARS-CoV-2）的传播已呈大流行态势，短短数周内便波及全球213余个国家。在此背景下，多项将止血功能紊乱与新型冠状病毒感染的动态进程相关联的研究相继问世。此类研究证实，部分感染2019冠状病毒病（Coronavirus Disease 2019，COVID-19）的患者可出现凝血酶原时间（prothrombin time，PT）延长、活化部分凝血活酶时间（activated partial thromboplastin time，APTT）升高，D-二聚体及其他纤溶产物水平升高，抗凝血酶（antithrombin，AT）活性降低，同时血小板计数下降。基于上述特征，本综述旨在系统阐述新型冠状病毒肺炎病理进程中所观察到的止血改变可能涉及的病理生理机制。本次分析进一步指出，除了与血小板减少症及纤溶亢进进展相关的临床事件外，血管紧张素转换酶2（angiotensin-converting enzyme 2，ACE2）的表达下调与细胞因子风暴的作用，同样与高凝状态的发生密切相关。