Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past

Abstract

Coronavirus disease 2019 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus strain disease, has recently emerged in China and rapidly spread worldwide. This novel strain is highly transmittable and severe disease has been reported in up to 16% of hospitalized cases. More than 600,000 cases have been confirmed and the number of deaths is constantly increasing. COVID-19 hospitalized patients, especially those suffering from severe respiratory or systemic manifestations, fall under the spectrum of the acutely ill medical population, which is at increased venous thromboembolism risk. Thrombotic complications seem to emerge as an important issue in patients infected with COVID-19. Preliminary reports on COVID-19 patients' clinical and laboratory findings include thrombocytopenia, elevated D-dimer, prolonged prothrombin time, and disseminated intravascular coagulation. As the pandemic is spreading and the whole picture is yet unknown, we highlight the importance of coagulation disorders in COVID-19 infected patients and review relevant data of previous coronavirus epidemics caused by the severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and the Middle East Respiratory Syndrome coronavirus (MERS-CoV).

Emergency room neurology in times of COVID‐19: malignant ischaemic stroke and SARS‐CoV‐2 infection

“…It is well known that COVID infection can induce changes in coagulation and other laboratory findings such as thrombocytopenia, elevated D-dimers, prolonged prothrombin time, and disseminated intravascular coagulation which can lead to the development of thrombosis. However, its effects on systemic circulation and coagulation have not yet been established [3,4]. Under these circumstances, neurologists were fearing the collapse of our units and planning how to deal with the potential increase of our stroke patients.…”

Early Safety Indicators of COVID-19 Convalescent Plasma in 5,000 Patients

“…risk for convalescent plasma use in COVID-19 is the possibility that it could exacerbate the type of coagulation derangements associated with advanced COVID-19 (31).…”

COVID-19 — Toward a comprehensive understanding of the disease

“…But it was the first reports from Italy and other European countries, which emphasized the remarkably high incidence of pulmonary embolism and thrombosis in the most severe and fatal cases [59,60,63]. At present, there is an awareness of a few clinical and laboratory features of patients with COVID-19, which is thrombocytopenia, elevated d-dimer level, prothrombin time prolongation and disseminated intravascular coagulation [64,65]. The International Society of Thrombosis and Hemostasis (ISTH) recommends prothrombin time, platelet, fibrinogen and d-dimer to determine prognosis and identify patients requiring admission to hospital [65].…”

“…The rise of d-dimer, seen in the majority of patients with confirmed COVID-19, may be due to the fibrinolytic processes and subsequent spillover into the bloodstream [66,67]. The hypercoagulable state can be explained by systemic inflammatory response alone, resulting in both massive activation of coagulative pathways, and at the same time, inhibition of fibrinolysis, which may be caused by up-regulation of PAI1 gene [64]. Coagulation disorders are correlated with the severity of bacterial and viral infections [68].…”