The Urgent Need to Understand Covid-19 Associated Coagulopathies and the Significance of Thrombotic Prophylaxis in Critically Ill Patients

ABSTRACT

BACKGROUND COVID-19 is a novel disease caused due to infection from the respiratory pathogen SARS CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). It originated from the city of Wuhan in China in December 2019, and spread to become a pandemic in most of the world. The World Health Organization (WHO) declared COVID-19 to be a `public health emergency of international concern' on January 30, 2020. Since then there have been countless cases and associated fatalities. In this article we focus on one aspect of the underlying conditions that may prove to be fatal in critically ill patients of COVID-19, namely hypercoagulative states and their associated thrombotic complications. We analyse data-driven studies that outline the manifold increase in instances of COVID-19 related thrombotic events and the patient demography that is most affected by it. There are several reflections and critical enumerations of the specific clinical features that patients with COVID-19 associated coagulopathies present with. We analyse and comment on several anecdotal instances of patients presenting with new-onset symptoms of severe large-vessel ischemic strokes and other coagulopathies. We determine how laboratory findings and specific markers can help identify patients most at risk of thrombotic events. These events may range from deep vein thromboses to fatal cerebrovascular accidents. There is an increased stress on how these coagulation problems may relate to other infectious conditions through presentation with similar markers. We also analyse the radiological investigations that such patients yield and identify peculiarities in them. There is further emphasis on the importance and efficacy of thrombotic prophylaxis and anticoagulant therapy in the management and reduction of fatalities. We also attempt to educate clinicians and intensive care providers regarding better management practices to mitigate fatal outcomes, including both pharmacological and supportive interventions.