Four years into the pandemic, managing COVID-19 patients with acute coagulopathy: what have we learned?

• DOI: 10.1016/j.jtha.2024.02.013
• Publication Date: 2024-02-29T06:43:05Z
• Authors: Toshiaki Iba; Jerrold H. Levy; Cheryl L. Maier; Jean M. Connors; Marcel Levi
• Keywords: Pandemic; 2019-20 coronavirus outbreak; Coronavirus Infections; Betacoronavirus

Coagulopathy alongside micro- and macrovascular thrombotic events were frequent characteristics of patients presenting with acute COVID-19 during the initial stages of the pandemic. However, over the past 4 years, the incidence and manifestations of COVID-19-associated coagulopathy have changed due to immunity from natural infection and vaccination and the appearance of new SARS-CoV-2 variants. Diagnostic criteria and management strategies based on early experience and studies for COVID-19-associated coagulopathy thus require reevaluation. As many other infectious disease states are also associated with hemostatic dysfunction, the coagulopathy associated with COVID-19 may be compounded, especially throughout the winter months, in patients with diverse etiologies of COVID-19 and other infections. This commentary examines what we have learned about COVID-19-associated coagulopathy throughout the pandemic and how we might best prepare to mitigate the hemostatic consequences of emerging infection agents.