D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis

Lippi, Giuseppe; Favaloro, Emmanuel J.

doi:10.1055/s-0040-1709650

Cited by 548 publications

(584 citation statements)

References 12 publications

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“…The most consistent hemostatic abnormalities with COVID-19 include mild thrombocytopenia (22) and increased D-dimer levels (23), which are associated with a higher risk of requiring mechanical ventilation, intensive care unit [ICU] admission, or death. Data related to other tests are less certain and often contradictory (24,25).…”

Section: Covid-19 and Hemostasis Parametersmentioning

confidence: 99%

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

Bikdeli

Madhavan

Jiménez

et al. 2020

Journal of the American College of Cardiology

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Patients with acute respiratory distress syndrome due to infection with the novel coronavirus SARS-COV2 are currently considered at high risk of developing thromboembolic complications in both venous and arterial vessels. The use of anticoagulants for preventive or curative purposes should be considered to reduce the risk of thromboembolic events. We report a case of a patient with severe COVID-19 acute respiratory distress syndrome who consecutively developed a right femoral deep vein thrombosis related to the femoral central line and acute ischemia of the left upper limb related to a radial arterial line. He was under a therapeutic dose of low molecular weight heparin twice a day three days before. The femoral vein was free of thrombosis while the central line was placed under a duplex ultrasound. Thromboembolic events can occur in patients with severe COVID-19 despite therapeutic anticoagulants. Close monitoring of vascular access with duplex ultrasound may be required.

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Section: Covid-19 and Hemostasis Parametersmentioning

confidence: 99%

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

Bikdeli

Madhavan

Jiménez

et al. 2020

Journal of the American College of Cardiology

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2,748

3,005

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“…Routine coagulation testing demonstrated a prothrombin time (PT) of 12.2 seconds (normal 9.4‐15.4 seconds), a partial thromboplastin time (PTT) of 30 seconds (normal 26‐38 seconds), and D‐dimers of 2143 ng/mL fibrinogen equivalent units (FEU; normal <600 ng/mL FEU), the last associated with severe COVID‐19 6 . Viscoelastic testing demonstrated a hypercoagulable profile (see Fig.…”

Section: Figurementioning

confidence: 99%

Viscoelastic testing in COVID‐19: a possible screening tool for severe disease?

et al. 2020

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) that manifests with variable severity. 1 A subset of symptomatic individuals develop proinflammatory or prothrombotic profiles requiring additional testing and interventions. [2][3][4][5] It is unclear which COVID-19 patients will ultimately develop severe disease that would have benefitted from early and aggressive interventions.A 63-year-old man was admitted with rapidly progressive COVID-19 pneumonia with hypoxia. Given the patient's worsening clinical status, laboratory coagulation analysis, including viscoelastic testing by rotational thromboelastometry (ROTEM delta, Instrumentation Laboratory Co., Bedford, MA), was performed immediately upon hospital admission. He subsequently developed acute respiratory distress syndrome and shock that required mechanical ventilation and vasopressor support.Routine coagulation testing demonstrated a prothrombin time (PT) of 12.2 seconds (normal 9.4-15.4 seconds), a partial thromboplastin time (PTT) of 30 seconds (normal 26-38 seconds), and D-dimers of 2143 ng/mL fibrinogen equivalent units (FEU; normal <600 ng/mL FEU), the last associated with severe COVID-19. 6 Viscoelastic testing demonstrated a hypercoagulable profile (see Fig. 1). 7 In particular, there was elevated maximum clot firmness observed on EXTEM (78 mm), INTEM Fig 1 Viscoelastic testing tracings from an intensive care unit patient with severe COVID-19. (A) EXTEM tracing; (B) INTEM tracing; (C) FIBTEM tracing; (D) APTEM tracing.

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“…Approximately one-fifth of the infected individuals develops severe to critical disease requiring intensive care support a cause of pneumonia [1]. As recent literature data described, severe COVID-19 is commonly complicated with coagulopathy with elevated D-dimer [1][2][3][4]; moreover, a pooled analysis showed that D-dimer values are considerably higher in COVID-19 patients with severe disease than those without [5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia

Pavoni¹,

Gianesello

Pazzi³

et al. 2020

J Thromb Thrombolysis

188

204

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Critically ill patients with COVID-19 pneumonia suffered both high thrombotic and bleeding risk. The effect of SARS-CoV-2 on coagulation and fibrinolysis is not well known. We conducted a retrospective study of critically ill patients admitted to an intensive care unit (ICU) a cause of severe COVID-19 pneumonia and we evaluated coagulation function using rotational thromboelastometry (ROTEM) on day of admission (T0) and 5 (T5) and 10 (T10) days after admission to ICU. Coagulation standard parameters were also evaluated. Forty patients were enrolled into the study. The ICU and the hospital mortality were 10% and 12.5%, respectively. On ICU admission, prothrombin time was slightly reduced and it increased significantly at T10 (T0 = 65.1 ± 9.8 vs T10 = 85.7 ± 1.5, p = 0.002), while activated partial thromboplastin time and fibrinogen values were higher at T0 than T10 (32.2 ± 2.9 vs 27.2 ± 2.1, p = 0.017 and 895.1 ± 110 vs 332.5 ± 50, p = 0.002, respectively); moreover, whole blood thromboelastometry profiles were consistent with hypercoagulability characterized by an acceleration of the propagation phase of blood clot formation [i.e., CFT below the lower limit in INTEM 16/40 patients (40%) and EXTEM 20/40 patients (50%)] and significant higher clot strength [MCF above the upper limit in INTEM 20/40 patients (50%), in EXTEM 28/40 patients (70%) and in FIBTEM 29/40 patients (72.5%)]; however, this hypercoagulable state persists in the first five days, but it decreases ten day after, without returning to normal values. No sign of secondary hyperfibrinolysis or sepsis induced coagulopathy (SIC) were found during the study period. In six patients (15%) a deep vein thrombosis and in 2 patients (5%) a thromboembolic event, were found; 12 patients (30%) had a catheter-related thrombosis. ROTEM analysis confirms that patients with severe COVID-19 pneumonia had a hypercoagulation state that persisted over time.

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D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis

Abstract: Fig. 1 Weighted mean difference and 95% confidence interval of D-dimer values between patients with or without severe form of coronavirus disease 2019.

Cited by 548 publications

References 12 publications

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

Viscoelastic testing in COVID‐19: a possible screening tool for severe disease?

Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia

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