Assessment and Monitoring of Coagulation in Patients with COVID-19: A Review of Current Literature

Abstract

Coagulation abnormalities are common in patients with COVID-19 and associated with high morbidity and mortality. It became a daily challenge to navigate through these abnormal laboratory findings and deliver the best possible treatment to the patients. The unique character of COVID-19-induced coagulopathy necessitates not only a dynamic follow-up of the patients in terms of hemostatic findings but also the introduction of new diagnostic methods to determine the overall function of the coagulation system in real time. After the recognition of the high risk of thromboembolism in COVID-19, several professional societies published their recommendations regarding anticoagulation in patients with COVID-19. This review summarizes common hemostatic findings in COVID-19 patients and presents the societal recommendations regarding the use of coagulation laboratory findings in clinical decision-making. Although several studies have investigated coagulation parameters in patients with COVID-19, the methodological shortcomings of published studies as well as the differences in employed anticoagulation regimens that have changed over time, depending on national and international guidelines, limit the applicability of these findings in other clinical settings. Accordingly, evidence-based recommendations for diagnostics during acute COVID-19 infection are still lacking. Future studies should verify the role of coagulation parameters as well as viscoelastic methods in the management of patients with COVID-19.

Coagulation profile in hospitalized children with COVID-19: pediatric age dependency and its impact on long COVID development

“…The pathological aspects of thromboinflammation involve interconnected processes, including endothelial damage, thrombus formation through platelet activation, and the coagulation cascade ( 14 , 16 , 19 ). In COVID-19, thromboinflammation induces endothelial damage by generating proinflammatory cytokines and triggering platelets and the complement system ( 2 , 23 ).…”

“…It was observed in patients with a severe course of COVID-19 and involved diffuse coagulation activation but with a pattern distinct from classical disseminated intravascular coagulation (DIC) syndrome. Although D-dimers may be noticeably elevated, in COVID-19, prothrombin time and activated partial thromboplastin time are only slightly prolonged, fibrinogen is increased, and the platelet count is usually normal or moderately decreased in a significant portion of hospitalized patients ( 13 , 14 ). COVID-19 coagulopathy is prothrombotic and does not result in hemorrhagic complications ( 14 ).…”

“…Although D-dimers may be noticeably elevated, in COVID-19, prothrombin time and activated partial thromboplastin time are only slightly prolonged, fibrinogen is increased, and the platelet count is usually normal or moderately decreased in a significant portion of hospitalized patients ( 13 , 14 ). COVID-19 coagulopathy is prothrombotic and does not result in hemorrhagic complications ( 14 ).…”

Yoğun Bakımdaki COVID-19 Hastalarında Prognostik Belirteçler: Hemostatik Parametreler Mortaliteyi Öngörebilir mi?

“…Yetişkin COVID-19 hastalarının mortalite risk faktörlerinin araştırıldığı bir çalışmada PLT düşüklüğü ve PT<16 sn olması mortalite ile ilişkili bulunmuştur (4). Koagülasyon parametrelerinin değerlendirildiği bir derlemede aPTT ve PLT değerleri mortalite için öngörücü bulunmuş, fibrinojen yüksekliğinin YB'a yatış ile ilişkisi belirlenmiştir (24). Literatürde araştırma sonucumuza benzer şekilde, aPTT, fibrinojenin prognozda öngörücü olmadığını değerlendiren çalışmalar da bulunmaktadır (1,19,25).…”

Laboratory Testing: Current Aspects

“…In view of the high risk of thromboembolism in COVID-19, several medical societies published recommendations with respect to diagnosis and anticoagulation in affected patients. The aim of the present manuscript by Uzun et al 5 was to describe common hemostatic findings in COVID-19 and to summarize different recommendations with respect to laboratory findings and corresponding treatment-decisions. While providing an excellent overview on the published information and guidance on this topic, the authors also highlight the need of future studies to provide evidence-based recommendations for diagnostics during acute COVID-19 infection.…”