REVIEW ARTICLEThrombohaemorhhagic balance in coronavirus disease 2019 and its management: a perspectiveGhosh, Kanjakshaa,∗; Ghosh, Malayb,∗†Author Information aThrombosis and Haemostasis Unit bFormerly Head of the Department of Haematology, Nil Ratan Sircar Medical College, Kolkata 7000'2, India Correspondence to Kanjaksha Ghosh, C403/404 Velentine Apartments (A2 Block), Gen AK Vaidya Marg & Film City Road Junction, Malad (E), Mumbai 400097, India Tel: +91 9892402588/+91 22 24138518; e-mail: [email protected] Received 15 July, 2020 Revised 29 October, 2020 Accepted 3 November, 2020 Blood Coagulation & Fibrinolysis: April 2021 - Volume 32 - Issue 3 - p 167-171 doi: 10.1097/MBC.0000000000000993 Buy Metrics Abstract Coronavirus disease 2019 infection produce a prothrombotic state. This is initiated through multiple pathways and is finally aggravated by cross talks with cytokine storm and neutrophil, platelet, complement activation. All these combine towards the second week of illness to produce thrombosis in the lung capillaries surrounding the alveolus producing characteristic pulmonary dysfunction (PaO2/FiO2 > 300, normal or minimally increased lung compliance and very high d-dimer levels) and a high rate of peripheral venous thrombosis. International and many national guidelines have approached this state in different ways but all emphasized the need for management and prevention of widespread thrombosis. It is felt more aggressive and graded thrombosis prevention and management should be initiated early in the treatment. d-Dimer, neutrophil count, SaO2, fibrinogen levels should be used to control the hypercoagulability. Drugs like statins which have anti-inflammatory action as well as ability to reduce fibrinogen and other clotting factors should be used in the beginning along with antiplatelet drugs and progressively complement activation and neutrophil extracellular traps inhibitors, oral mucopolysaccharides, full-scale anticoagulation along with judicial use of fibrinolysis supporting drugs should be added. In the present review, we have evaluated the various studies and argued the rationality that the anticoagulation in this condition should be initiated early during the infection and should be increased in a graded manner depending on clinical and laboratory progression of the condition until a strong specific antiviral drug for coronavirus disease 2019 infection is available. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.