Particularities of hemostasis changes in COVID-19 patients

Authors: Vasilieva E.Yu., Kalinskaya A.I.

Company: A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, 127473, Russian Federation

For correspondence:  Sign in or register.

Type:  Editorial article


For citation: Vasilieva E., Kalinskaya A. Particularities of hemostasis changes in COVID-19 patients. Creative Cardiology. 2021; 15 (1): 5–8 (in Russ.). DOI: 10.24022/1997-3187-2021-15-1-5-8

Received / Accepted:  02.03.2021 / 05.03.2021

Keywords: COVID-19 plasma coagulation endothelial dysfunction platelet activation

Subscribe 🔒



COVID-19 infection is characterized by different clinical presentations. The thrombotic complications play the leading role in COVID-19 infection. SARS-CoV-2 virus can activate hemostasis at different levels: pulmonary tissue damage with subsequent plasma coagulation activation; local endothelial dysfunction and platelet activation during the course of the disease. Routine use of the anticoagulation treatment seems reasonable in hospitalized patients with COVID-19.


  1. Donald J.S., Naimo P.S., d'Udekem Y., Richardson M., Bullock A., Weintraub R.G. et al. Outcomes of subaortic obstruction resection in children. Heart Lung. Circ. 2017; 26 (2): 179–86. DOI: 10.1016/j.hlc.2016.05.120
  2. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb. Haemost. 2020; 18: 844–7. DOI: 10.1111/jth.14768 2. Klok F., Kruip M., van der Meer N., Arbous M., Gommers D., Kant K. et al. Incidence of thrombotic complications in critically ill ICU patients8 Creative Cardiology. 2021; 15 (1) DOI: 10.24022/1997-3187-2021-15-1-5-8 Editorial article with COVID-19. Thromb. Res. 2020; 191: 145–7. DOI: 10.1016/j.thromres.2020.04.013
  3. Nahum J., Morichau-Beauchant T., Daviaud D., Echegut P., Fichet J., Maillet J. et al. Venous thrombosis among critically ill patients with coronavirus disease 2019 (COVID-19). JAMA Netw Open. 2020; 3 (5): e2010478. DOI: 10.1001/jamanetworkopen.2020.10478
  4. Carsana L., Sonzogni A., Nasr A., Simona Rossi R., Pellegrinelli A., Zerbi P. et al. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect. Dis. 2020. DOI: 10.1016/S1473-3099(20)30434-5
  5. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497–506. DOI: 10.1016/S0140- 6736(20)30183-5
  6. Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J. Thromb. Haemost. 2020; 18. DOI: 10.1111/jth.14817
  7. Varga Z., Flammer A., Steiger P., Haberecker M., Andermatt R., Zinkernagel A. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020; 395: 1417–8. DOI: 10.1016/S0140- 6736(20)30937-5
  8. Jin Y., Ji W., Yang H., Chen S., Zhang W., Duan G. et al. Endothelial activation and dysfunction in COVID-19: from basic mechanisms to potential therapeutic approaches. Sign. Transduct. Target. Ther. 2020; 5: 1–13. DOI: 10.1038/s41392-020- 00454-7
  9. Mancini I., Baronciani L., Artoni A., Colpani P., Biganzoli M., Gozzi G. et al. The ADAMTS13_von Willebrand factor axis in COVID_19 patients. J. Thromb. Haemost. 2020. DOI: 10.1111/jth.15191. DOI: 10.1111/jth.15191
  10. Evans P.C., Rainger G., Mason J., Guzik T., Osto E., Stamataki Z. et al. Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science. Cardiovasc. Res. 2020; 116; 2177–84. DOI: 10.1093/cvr/cvaa230
  11. Ward S.E., Curley F., Lavin M., Fogarty H., Karampini E., McEvoy N. et al. Von Willebrand factor propeptide in severe coronavirus disease 2019 (COVID-19): evidence of acute and sustained endothelial cell activation. Br. J. Haematol. 2020. DOI: 10.1111/bjh.17273
  12. Bongiovanni D., Klug M., Lazareva O., Weidlich S., Biasi M., Ursu S. et al. SARS-CoV-2 infection is associated with a pro-thrombotic platelet phenotype. Cell Death Dis. 2021; 12: 1–10. DOI: 10.1038/s41419-020-03333-9
  13. Libby P., Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur. Heart J. 2020; 41; 3038–44. DOI: 10.1093/eurheartj/ehaa623
  14. Vasilieva E., Vorobyeva I., Lebedeva A., Urazovskaya I., Kalinskaya A., Skrypnik D. et al. Brachial artery flow-mediated dilation in patients with tako-tsubo cardiomyopathy. Am. J. Med. 2011; 124: 1176–9. DOI: 10.1016/j.amjmed.2011.05.033
  15. Vasilieva E., Urazovskaya I., Skrypnik D., Shpektor A. Total occlusion of the infarct-related coronary artery correlates with brachial artery flow-mediated dilation in patients with ST-elevation myocardial infarction. Acute Card. Care. 2009; 11: 155–9. DOI: 10.1080/17482940902763372
  16. Васильева Е.Ю., Воробьева И.И., Калинская А.И., Лебедева А.М., Скрыпник Д.В., Уразовская И.Л., Шпектор А.В. Эндотелийзависимая вазодилатация плечевой артерии у пациентов с кардиомиопатией Такотсубо. Креативная кардиология. 2012; 6: 80–5.
  17. Лебедева А.М., Васильева Е.Ю., Шпектор А.В. Кардиомиопатия Такотсубо (часть 1). Креативная кардиология. 2012; 6: 123–32.
  18. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J. Am. Med. Assoc. 2020; 323: 1061–9. DOI: 10.1001/jama.2020.1585
  19. Comer S., Cullivan S., Szklanna P., Weiss L., Cullen S., Kelliher S. et al. COVID-19 induces a hyperactive phenotype in circulating platelets. PLOS Biol. 2021; 19: e3001109. DOI: 10.1371/journal.pbio.3001109
  20. Canzano P., Brambilla M., Porro B., Cosentino N., Tortorici E., Vicini S. et al. Platelet and endothelial activation as potential mechanisms behind the thrombotic complications of COVID19 Patients. JACC Basic to Transl. Sci. 2021; 6: 202–18. DOI: 10.1016/j.jacbts.2020.12.009
  21. Ostergaard S., Schmidt M., Horváth-Puhó E., Thomsen R., Sо/rensen H. Thromboembolism and the Oxford–AstraZeneca COVID-19 vaccine: side-effect or coincidence? Lancet. 2021. DOI: 10.1016/S0140-6736(21)00762-5
  22. Kalinskaya A., Dukhin O., Molodtsov I., Maltseva A., Sokorev D., Elizarova A. et al. Dynamics of coagulopathy in patients with different COVID-19 severity. medRxiv. 2020. DOI: 10.1101/2020.07.02.20145284
  23. Panigada M., Bottina N., Tagliabue P., Grasselli G., Novembrino C., Chantarangkul V. et al. Hypercoagulability of COVID-19 patients in intensive care unit. a report of thromboelastography findings and other parameters of hemostasis. J. Thromb. Haemost. 2020. DOI: 10.1111/jth.14850
  24. Van Veenendaal N., Scheeren T., Meijer K., van der Voort P. Rotational thromboelastometry to assess hypercoagulability in COVID-19 patients. Thromb. Res. 2020; 196: 379–81. DOI: 10.1016/j.thromres.2020.08.046

About Authors

  • Васильева Елена Юрьевна, доктор мед. наук, профессор, заведующий лабораторией, ORCID
  • Калинская Анна Ильинична, канд. мед. наук, доцент, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery