Coagulopathy in COVID-19: Manifestations and management

Mucha, Simon; Dugar, Siddharth; McCrae, Keith R.; Joseph, Douglas; Bartholomew, John R.; Sacha, Gretchen L.; Militello, Michael

doi:10.3949/ccjm.87a.ccc024

Cited by 94 publications

(93 citation statements)

References 41 publications

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“…Therefore, early elevated plasma fibrinogen level may be a risk marker for the severe acute respiratory syndrome development 42 . But there are also authors who found normal plasma fibrinogen levels 41 . Moreover, they consider that high level of plasma D-dimer that coexists with normal fibrinogen levels is a characteristic finding in these patients and correlates with the disease severity and thrombotic risk 41 .…”

Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

“…But there are also authors who found normal plasma fibrinogen levels 41 . Moreover, they consider that high level of plasma D-dimer that coexists with normal fibrinogen levels is a characteristic finding in these patients and correlates with the disease severity and thrombotic risk 41 . A level of D-dimer more than 6 times higher than the upper limit of normal values can be found in patients with the highest thrombotic risk 41 .…”

Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

“…Coagulation dysfunction in these patients is linked to the most severe course of the disease, with multiple organ failure and even death 33 . Therefore, the increased thrombotic risk of patients infected with COVID-19 contributes to their higher morbidity and mortality 41 .…”

Section: Is There a Thrombotic Or Hemorrhagic Risk?mentioning

confidence: 99%

“…Moreover, they consider that high level of plasma D-dimer that coexists with normal fibrinogen levels is a characteristic finding in these patients and correlates with the disease severity and thrombotic risk 41 . A level of D-dimer more than 6 times higher than the upper limit of normal values can be found in patients with the highest thrombotic risk 41 . High levels of D-dimers are associated with disease progression and may be the expression of fibrinolysis secondary to disseminated intravascular coagulation favored by infections and sepsis 34 .…”

Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

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Coagulation disorders in SARS-CoV-2 infection

Mihăilă¹,

Mihaila²

2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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A better understanding of the pathogenetic mechanisms triggered by SARS-CoV-2 infection may contribute to a more effective management of patients with COVID-19. Coagulation dysfunction is a key pathogenetic element of this disease as well as a challenge for practitioners. Marked inflammatory process found in severe forms of COVID-19, the complement activation, the cytokine storm, and disruption of the renin-angiotensin-aldosterone system are involved in the onset of thrombotic microangiopathy and large vessel coagulopathy. Virus-induced procoagulant activity occurs at the systemic level. Intravascular microthrombi disrupt vascularization in various tissues and organs, contributing to the occurrence of multiorgan failure and explain the higher morbidity and all-cause mortality of patients. It is estimated that almost 20% of patients with COVID-19 have significant coagulation disorders, and about a quarter of those hospitalized in intensive care units are prone to develop thrombosis events under prophylactic anticoagulant treatment. Some of patients who have been immunized after healing from the SARS-CoV-2 infection have a hypercoagulable state and are prone to develop thrombosis. Hypercoagulability is supported by thrombelastographic analysis: patients have an acceleration of the propagation phase of blood clot formation and higher clot strength. Markers of coagulation dysfunction in SARS-CoV2 are: decreased platelet count, increased INR, presence of fibrin degradation products, and especially higher plasma levels of D-dimers, which predict unfavorable outcome in these patients. Age, pre-existing diseases and associated risk factors, together with careful monitoring of clinical evolution and laboratory parameters allow the choice of the best personalized prophylactic or curative anticoagulant treatment.

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Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

Section: Is There a Thrombotic Or Hemorrhagic Risk?mentioning

confidence: 99%

Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

See 2 more Smart Citations

Coagulation disorders in SARS-CoV-2 infection

Mihăilă¹,

Mihaila²

2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…COVID-19 is a multisystem disease which increases risk of coagulopathy and thus, venous thromboembolism (VTE) and pulmonary embolism (PE) in critically ill patients. The incidence rate for VTE and arterial thrombosis and related thrombo-embolic complications remain very high in COVID-19 patients [ 1 ]. There are three possible mechanisms associated with this observation: (1) through cytokine storm by interleukin-1, interleukin-6, tumor necrosis factor-alpha and others leading to endothelial activation and widespread thrombosis as seen in pulmonary vessels in acute respiratory distress syndrome; (2) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown an affinity for angiotensin-converting enzyme 2 located at alveolar epithelial cells, endothelial cells of extrapulmonary tissues leading to thrombosis by microvascular injury and multiorgan failure; and (3) lupus anticoagulant antibodies can lead to thrombosis by the “two hit” thrombosis model [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Pulmonary Embolism in COVID-19: a Pooled Analysis

Desai

Gandhi

Singh

et al. 2020

SN Compr. Clin. Med.

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There remains a high risk of thrombosis in patients affected by the SARS-CoV-2 virus and recent reports have shown pulmonary embolism (PE) as a cause of sudden death in these patients. However, the pooled rate of this deadly and frequently underdiagnosed condition among COVID-19 patients remains largely unknown. Given the frequency with which pulmonary embolism has been reported as a fatal complication of severe coronavirus disease, we sought to ascertain the actual prevalence of this event in COVID-19 patients. Using PubMed/Medline, EMBASE, and SCOPUS, a thorough literature search was performed to identify the studies reporting rate of PE among COVID-19. Random effects models were obtained to perform a meta-analysis, and I 2 statistics were used to measure inter-study heterogeneity. Among 3066 COVID-19 patients included from 9 studies, the pooled prevalence of PE was 15.8% (95% CI (6.0–28.8%), I 2 = 98%). The pooled rate in younger cohort (age < 65 years) showed a higher prevalence of 20.5% (95% CI (17.6–24.8%)) as compared to studies including relatively older cohort (age > 65 years) showing 14.3% (95% CI (2.9–30.1%)) ( p < 0.05). Single-center studies showed a prevalence of 12.9% (95% CI 1.0–30.2%), while that of multicenter studies was 19.5% (95% CI 14.9–25.2%) ( p < 0.05). Pulmonary embolism is a common complication of severe coronavirus disease and a high degree of clinical suspicion for its diagnosis should be maintained in critically ill patients.

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Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19

et al. 2021

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Key Points Question Which patients with COVID-19 may benefit from extended thromboprophylaxis following hospital discharge? Findings In this cohort study of 2832 patients hospitalized with COVID-19, postdischarge venous thromboembolic events occurred more often in those with a history of venous thromboembolism, peak dimerized plasmin fragment D (D-dimer) level greater than 3 μg/mL, and predischarge C-reactive protein level greater than 10 mg/dL. Patients who received postdischarge anticoagulation therapy had fewer events. Meaning These findings suggest that postdischarge anticoagulation therapy may be considered for high-risk patients with COVID-19.

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Coagulopathy in COVID-19: Manifestations and management

Cited by 94 publications

References 41 publications

Coagulation disorders in SARS-CoV-2 infection

Coagulation disorders in SARS-CoV-2 infection

Prevalence of Pulmonary Embolism in COVID-19: a Pooled Analysis

Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19

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