Covid‐19 and Liver Injury: Role of Inflammatory Endotheliopathy, Platelet Dysfunction, and Thrombosis

Liver injury, characterized predominantly by elevated aspartate aminotransferase and alanine aminotransferase, is a common feature of coronavirus disease 2019 (COVID‐19) symptoms caused by severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2). Additionally, SARS‐CoV‐2 infection is associated with acute‐on‐chronic liver failure in patients with cirrhosis and has a notably elevated mortality in patients with alcohol‐related liver disease compared to other etiologies. Direct viral infection of the liver with SARS‐CoV‐2 remains controversial, and alternative pathophysiologic explanations for its hepatic effects are an area of active investigation. In this review, we discuss the effects of SARS‐CoV‐2 and the inflammatory environment it creates on endothelial cells and platelets more generally and then with a hepatic focus. In doing this, we present vascular inflammation and thrombosis as a potential mechanism of liver injury and liver‐related complications in COVID‐19.