Review Article

Koagulopati pada Coronavirus Disease-2019 (COVID-19): Tinjauan pustaka

Herick Alvenus Willim , Amanda Trixie Hardigaloeh, Alice Inda Supit, Handriyani Handriyani

Herick Alvenus Willim
Unit Pelayanan COVID-19, RS Universitas Tanjungpura, Pontianak, Kalimantan Barat, Indonesia. Email:

Amanda Trixie Hardigaloeh
Departemen Ilmu Penyakit Dalam, RSUD Sultan Syarif Mohamad Alkadrie, Pontianak, Kalimantan Barat, Indonesia

Alice Inda Supit
Departemen Kardiologi dan Kedokteran Vaskular, RSUD dr. Soedarso, Pontianak, Kalimantan Barat, Indonesia

Handriyani Handriyani
Departemen Pulmonologi dan Kedokteran Respirasi, RSUD Ade Mohamad Djoen, Sintang, Kalimantan Barat, Indonesia
Online First: December 01, 2020 | Cite this Article
Willim, H., Hardigaloeh, A., Supit, A., Handriyani, H. 2020. Koagulopati pada Coronavirus Disease-2019 (COVID-19): Tinjauan pustaka. Intisari Sains Medis 11(3): 749-756. DOI:10.15562/ism.v11i3.766

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 has spread globally and become a new pandemic. Although the clinical manifestation of COVID-19 mainly affected the respiratory system, coagulopathy often occurs in the severe cases and is associated with increased mortality. This literature review aims to provide a review of coagulopathy in COVID-19.

Methods: This literature review involved 52 relevant literature about coagulopathy and COVID-19. Different data sources or manual literature search methods used to find articles related to the topic of literature.

Results: COVID-19 can trigger cytokine storms and systemic hyperinflammation which cause increased activation of coagulation and resulting in hypercoagulability. Hypercoagulability state in COVID-19 increases the risk of thrombosis and thromboembolism, particularly venous thromboembolism. Prophylactic anticoagulants can prevent thromboembolic events and improve the prognosis of COVID-19 patients with coagulopathy.

Conclusion: The hypercoagulation state in COVID-19 can increase the risk of complications from thrombosis and thromboembolism, especially venous thromboembolism. Increased D-dimers are a marker of coagulopathy that is often found in patients with severe COVID-19 and is associated with disease severity.


Latar Belakang: Coronavirus disease 2019 (COVID-19) merupakan penyakit infeksi akibat severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 telah menyebar secara global dan menjadi pandemi baru. Walaupun manifestasi klinis COVID-19 terutama mengenai sistem respirasi, koagulopati seringkali terjadi pada kasus berat dan berhubungan dengan peningkatan mortalitas. Tinjauan pustaka ini bertujuan untuk memberikan ulasan mengenai koagulopati pada COVID-19.

Metode: Tinjauan pustaka ini melibatkan 52 literatur yang relevan tentang koagulopati dan COVID-19. Sumber data yang berbeda atau metode pencarian literatur manual digunakan untuk mencari artikel yang berkaitan dengan topik literatur.

Hasil: COVID-19 dapat memicu terjadinya badai sitokin dan hiperinflamasi sistemik yang menyebabkan terjadinya peningkatan aktivasi koagulasi dan mengakibatkan hiperkoagulasi. Keadaan hiperkoagulasi pada COVID-19 meningkatkan risiko terjadinya trombosis dan tromboemboli, terutama tromboemboli vena. Antikoagulan profilaksis dapat mencegah kejadian tromboemboli dan meningkatkan prognosis pada pasien COVID-19 dengan koagulopati.

Kesimpulan: Keadaan hiperkoagulasi pada COVID-19 dapat meningkatkan risiko terjadinya komplikasi trombosis dan tromboemboli, terutama tromboemboli vena. Peningkatan D-dimer merupakan penanda koagulopati yang sering ditemukan pada pasien COVID-19 berat dan berhubungan dengan keparahan penyakit.


Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020;7(1):11. doi: 10.1186/s40779-020-00240-0

World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. Geneva: WHO; 2020 [updated 2020 March 11; cited 2020 May 23]. Available from:

Cao W, Li T. COVID-19: towards understanding of pathogenesis. Call Res. 2020;30(5):367-369. doi: 10.1038/s41422-020-0327-4

Di Gennaro F, Pizzol D, Marotta C, Antunes M, Racalbuto V, Veronese N, et al. Coronavirus diseases (COVID-19) current status and future perspectives: A narrative review. Int. J Environ Res Public Health. 2020;17(8):E2690. doi: 10.3390/ijerph17082690

Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. doi: 10.1016/j.jinf.2020.04.021

Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J. 2020;55(5):2000547. doi: 10.1183/13993003.00547-2020

Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020. doi:

Henry BM, Vikse J, Benoit S, Favaloro EJ, Lippi G. Hyperinflammation and dearangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clin Chim Acta. 2020;507:167-173. doi: 10.1016/j.cca.2020.04.027

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14. doi: 10.1016/j.thromres.2020.04.024

Wichmann D, Sperhake JP, Lutgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020. doi: 10.7326/M20-2003

Kollias A, Kyriakoulis KG, Dimakakos E, Poulakou G, Stergion GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol. 2020. doi: 10.1111/bjh.16727

Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and multi-organ response. Curr Probl Cardiol. 2020. doi: 10.1016/j.cpcardiol.2020.100618

Nile SH, Nile A, Qiu J, Li L, Jia X, Kai G. COVID-19: Pathogenesis, cytokine storm and therapeutic potential of interferons. Cytokine Growth Factor Rev. 2020. doi: 10.1016/j.cytogfr.2020.05.002

Joly BS, Siguret V, Veyradier A. Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19. Intensive Care Med. 2020;1-4. doi: 10.1007/s00134-020-06088-1

Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020. doi: 10.1016/S0140-6736(20)30937-5

Ullah W, Saeed R, Sarwar U, Patel R, Fischman DL. COVID-19 complicated by acute pulmonary embolism and right-sided heart failure. JACC Case Rep. 2020. doi: 10.1016/j.jaccas.2020.04.008

Panigada M, Bottino 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

Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020. doi: 10.1111/jth.14849

Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020. doi: 10.1002/ajh.25829

Yao Y, Cao J, Wang Q, Liu K, Luo Z, Yu K, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case control study. Crit Care Emerg Med. 2020. doi: 10.21203/

Marietta M, Ageno W, Artoni A, Candia ED, Gresele P, Marchetti M, et al. COVID-19 and haemostasis: A position paper from Italian Society on Thrombosis and Haemostasis (SISET). Blood Transfus. 2020. doi: 10.2450/2020.0083-20

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395:1054-1062. doi: 10.1016/ S0140-6736(20)30566-3

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;00:1-4. doi: 10.1111/jth.14830

Klok FA, Kruip MJHA, Van Der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020. doi: 10.1016/j.thromres.2020.04.013

Khizroeva JH, Makatsariya AD, Bitsadze VO, Tretyakova MV, Slukhanchuk EV, Elalamy I, et al. Laboratory monitoring of COVID-19 patients and the significance of coagulopathy markers. Obstertrics, Gynecology and Reproduction. 2020. doi: 10.17749/2313-7347.141

Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020;99(6):1205-1208. doi: 10.1007/s00277-020-04019-0

Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020;00:1-4. doi: 10.1111/jth.14848

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;18:844-847. doi: 10.1111/jth.14768

Fogarty H, Townsend L, Cheallaigh CN, Bergin C, Martin-Loeches I, Browne P, et al. COVID-19 coagulopathy in Caucasian patients. Br J Haematol. 2020. doi: 10.1111/bjh.16749

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395:507-513. doi: 10.1016/ S0140-6736(20)30211-7

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(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5

Cannegieter SC, Klok FA. COVID-19 associated coagulopathy and thromboembolic disease: Commentary on an interim expert guidance. doi:

Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: Interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020. doi: 10.1007/s11239-020-02138-z

Mucha SR, Dugar S, McCrae K, Joseph DE, Bartholomew J, Sacha G, et al. Coagulopathy in COVID-19. Cleve Clin J Med. 2020. doi: 10.3949/ccjm.87a.ccc024

Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020. doi: 10.1182/blood.2020006000

Wang T, Chen R, Liu C, Liang W, Guan W, Tang R, et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol. 2020;7(5):e362-e363. doi: 10.1016/S2352-3026(20)30109-5

Li Y, Wang M, Zhou Y, Chang J. Acute cerebrovascular disease following COVID-19: A single center, retrospective, observational study. SSRN Electronic Journal. 2020. doi: 10.2139/ssrn.3550025

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020. doi: 10.1001/jamaneurol.2020.1127

Mestres G, Puigmacia R, Blanco C, Yugueros X, Esturrica M, Riambau V. Risk of peripheral arterial thrombosis in COVID-19. J Vasc Surg. doi: 10.1016/j.jvs.2020.04.477

National Institutes of Health. Antithrombotic therapy in patients with COVID-19 [Internet]. 2020 [updated 2020 May 12; cited 2020 May 24]. Available from:

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18:1023-1026. doi: 10.1111/jth.14810

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18:1094-1099. doi: 10.1111/jth.14817

Negri EM, Piloto BM, Morinaga LK, Jardim CVP, Lamy SAE, Ferreira MA, et al. Heparin therapy improving hypoxia in COVID-19 patient - a case series. MedRxiv Preprint. doi: 10.1101/2020.04.15.20067017

Poterucha TJ, Libby P, Goldhaber SZ. More than an anticoagulant: Do heparins have direct anti-inflammatory effects? Thromb Haemost. 2017;117:437-444. doi: 10.1160/TH16-08-0620

Becker RC. COVID-19 update: COVID-19-associated coagulopathy. J Thromb Thrombolysis. 2020:1-14. doi: 10.1007/s11239-020-02134-3

American Society of Hematology. COVID-19 and VTE/anticoagulation: frequently asked questions [Internet]. 2020 [updated 2020 May 18; cited 2020 May 24]. Available from:

Chen J, Yu Y, Fareed J, Hoppensteadt D, Jeske W, Kouta A, et al. Comparison of low-molecular-weight heparins prepared from ovine heparins with enoxaparin. Clin Appl Thromb Hemost. 2019;25:1-9. Clin Appl Thromb Hemost. doi: 10.1177/1076029619840701

Alquwaizani M, Buckley L, Adams C, Fanikos J. Anticoagulants: A review of the pharmacology, dosing, and complications. Curr Emerg Hosp Med Rep. 2013;1:83-97. doi: 10.1007/s40138-013-0014-6

Hunt B, Retter A, McClintock C. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19.

Viggiano GV, Cardillo G, Russo V, Mangiacapra S, Cavalli A, Pesci C, et al. FONDENOXAVID: A retrospective analysis on utility of thromboprophylaxis with fondaparinux and enoxaparin in patients with COVID19 infection in Italy. Preprints. 2020. doi: 10.20944/preprints202005.0309.v1

American Society of Hematology. COVID-19 and coagulopathy: frequently asked questions [Internet]. 2020 [updated 2020 May 18; cited 2020 May 25]. Available from:

Song JC, Wang G, Zhang W, Zhang Y, Li WQ, Zhou Z, et al. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res. 2020;7(1):19. doi: 10.1186/s40779-020-00247-7

No Supplementary Material available for this article.
Article Views      : 958
PDF Downloads : 664