COVID-19-associated coagulopathy and its role in gastroduodenal ulceration

Background. COVID-19-associated coagulopathy is a major manifestation of severe SARS-CoV-2 infection and is characterized by hypercoagulability, endothelial dysfunction, marked systemic inflammation, and microvascular dysfunction. Despite extensive research on hemostatic abnormalities in COVID-19, the role of COVID-19-associated coagulopathy in gastroduodenal ulcerative lesions complicated by gastrointestinal ulceration and gastrointestinal bleeding remains poorly understood.

Objective: To characterize COVID-19-associated coagulopathy in patients with gastroduodenal bleeding and determine the relationships between laboratory hemostatic parameters, the severity of lung involvement, hypoxemia, and the endoscopic characteristics of gastroduodenal ulceration.

Material and methods. This retrospective study included 72 patients with COVID-19 pneumonia complicated by gastroduodenal bleeding. The analysis included parameters of primary and secondary hemostasis, markers of systemic inflammation, the extent of lung involvement on computed tomography, oxygen saturation, and the morphological characteristics of the ulcers. Correlation and logistic regression analyses were performed to identify factors associated with in-hospital mortality.

Results. Patients exhibited pronounced COVID-19-associated coagulopathy, with elevated D-dimer and fibrinogen concentrations, increased C-reactive protein levels, and abnormalities of primary hemostasis. The extent of lung involvement and oxygen saturation were significantly associated with the morphological characteristics of the ulcers.

Conclusion. In patients with gastroduodenal bleeding, COVID-19-associated coagulopathy is characterized by both hypercoagulability and hypocoagulability in the setting of pronounced systemic inflammation. The extent of gastroduodenal ulceration is associated not only with laboratory manifestations of coagulopathy but also with the severity of lung involvement, hypoxemia, thrombocytopenia, and ulcer morphometry.

1. Ragnoli B., Da Re B., Galantino A., et al. Interrelationship between COVID-19 and coagulopathy: pathophysiological and clinical evidence. Int J Mol Sci. 2023; 24 (10): 8945. https://doi.org/10.3390/ijms24108945.

2. Iba T., Levy J.H., Maier C.L., et al. Four years into the pandemic, managing COVID-19 patients with acute coagulopathy: what have we learned? J Thromb Haemost. 2024; 22 (6): 1541–9. https://doi.org/10.1016/j.jtha.2024.02.013.

3. Abdollahi A., Nateghi S., Panahi Z., et al. The association between mortality due to COVID-19 and coagulative parameters: a systematic review and meta-analysis study. BMC Infect Dis. 2024; 24 (1): 1373. https://doi.org/10.1186/s12879-024-10229-y.

4. Obeagu E.I., Obeagu G.U. Thromboinflammation in COVID-19: unraveling the interplay between coagulation and inflammation. Medicine. 2024 Jul 12;103(28):e38922. https://doi.org/10.1097/MD.0000000000038922.

5. Obeagu E.I., Tukur M., Akaba K. Impacts of COVID-19 on hemostasis: coagulation abnormalities and management perspectives. Ann Med Surg. 2024; 86 (10): 5844–50. https://doi.org/10.1097/MS9.0000000000002237.

6. Ishikura H., Irie Y., Nakashio M., et al. Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von Willebrand syndrome. Sci Rep. 2025; 15 (1): 19321. https://doi.org/10.1038/s41598-025-99786-z.

7. Makatsariya A.D. (Ed.) COVID-19, thromboinflammation and thrombosis. Moscow: GEOTAR-Media; 2023: 184 pp. (in Russ.).

8. Beidollahkhani S., Fayedeh F., Shoja A., et al. d-dimer as a biomarker for COVID-19-associated pulmonary thromboembolism: a narrative review from molecular pathways to the imaging findings. Egyptian J Bronchol. 2023; 17: 44. https://doi.org/10.1186/s43168-023-00221-6.

9. Kornblith L.Z., Sadhanandhan B., Arun S., et al. γ′ fibrinogen levels as a biomarker of COVID-19 respiratory disease severity. Blood Cells Mol Dis. 2023; 101: 102746. https://doi.org/10.1016/j.bcmd.2023.102746.

10. Ayako R.M., Patel K., Ndede I., et al. Inflammatory, hematological, and biochemical biomarkers in COVID-19 patients. Immun Inflamm Dis. 2024; 12 (12): e70078. https://doi.org/10.1002/iid3.70078.

11. Siniscalchi C., Di Micco P., Guerra A., et al. Platelet count and clinical outcomes in hospitalized patients with COVID-19 pneumonia. Front Med. 2025; 12: 1614447. https://doi.org/10.3389/fmed.2025.1614447.

12. Subramaniam S., Mohiuddin N., Jose A. Does SARS-CoV-2 infect platelets? Front Immunol. 2024; 15: 1392000. https://doi.org/10.3389/fimmu.2024.1392000.

13. Lahane V., Acharya S., Shukla S., et al. Platelet indices as novel surrogate markers for the prognosis of COVID-19 infection: an observational study. Cureus. 2024; 16 (6): e62243. https://doi.org/10.7759/cureus.62243.

14. Karlafti E., Tsavdaris D., Kotzakioulafi E., et al. The prevalence of gastrointestinal bleeding in COVID-19 patients: a systematic review and meta-analysis. Medicina. 2023; 59 (8): 1500. https://doi.org/10.3390/medicina59081500.

15. Rathore S.S., Wint Z.S., Goyal A., et al. Prevalence and outcomes of upper gastrointestinal bleeding in COVID-19: a systematic review and meta-analysis. Rev Med Virol. 2024; 34 (1): e2509. https://doi.org/10.1002/rmv.2509.

16. Jaan A., Sarfraz Z., Farooq U., et al. Nonvariceal upper gastrointestinal bleeding in COVID-19 patients: insights from the National Inpatient Sample. Scand J Gastroenterol. 2024; 59 (5): 615–22. https://doi.org/10.1080/00365521.2024.2310161.

17. Al Hanaei A., AlKindi F., Alkhemeiri A., Nair S.C. Gastrointestinal bleeding in COVID-19 infected patients, and management outcomes. Int J Gen Med. 2024; 17: 1145–53. https://doi.org/10.2147/IJGM.S454841.

18. Shafieipour S., Rezaei Zadeh Rukerd M, Farsiu N., et al. COVID-19 and upper gastrointestinal bleeding; etiology, risk factors, and outcomes: a case-control study. Middle East J Dig Dis. 2025; 17 (1): 25–30. https://doi.org/10.34172/mejdd.2025.406.

19. Ikiz F., Ak A. Investigation of the relationship between coagulation parameters and mortality in COVID-19 infection. Blood Sci. 2024; 6 (2): e00191. https://doi.org/10.1097/BS9.0000000000000191.

20. Aditianingsih D., Soenarto R.F., Puiantana A.M., et al. Dose-response relationship between D-dimer level and mortality in critically ill COVID-19 patients: a retrospective observational study. F1000Res. 2023 Jan 10:11:269. https://doi.org/10.12688/f1000research.108972.2.

21. Luzak B., Golanski J., Rozalski M. Complex pattern of platelet activation/reactivity after SARS-CoV-2 infection. Int J Mol Sci. 2024; 26 (1): 49. https://doi.org/10.3390/ijms26010049.