Prominent changes in blood coagulation of patients with SARS-CoV-2 infection

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_cclm-2020-0188_s_999_w2aab3b7b4b1b6b1aab1c16b1Aa"><jats:title>Background</jats:title><jats:p>As the number of patients increases, there is a growing understanding of the form of pneumonia sustained by the 2019 novel coronavirus (SARS-CoV-2), which has caused an outbreak in China. Up to now, clinical features and treatment of patients infected with SARS-CoV-2 have been reported in detail. However, the relationship between SARS-CoV-2 and coagulation has been scarcely addressed. Our aim is to investigate the blood coagulation function of patients with SARS-CoV-2 infection.</jats:p></jats:sec><jats:sec id="j_cclm-2020-0188_s_998_w2aab3b7b4b1b6b1aab1c16b2Aa"><jats:title>Methods</jats:title><jats:p>In our study, 94 patients with confirmed SARS-CoV-2 infection were admitted in Renmin Hospital of Wuhan University. We prospectively collect blood coagulation data in these patients and in 40 healthy controls during the same period.</jats:p></jats:sec><jats:sec id="j_cclm-2020-0188_s_997_w2aab3b7b4b1b6b1aab1c16b3Aa"><jats:title>Results</jats:title><jats:p>Antithrombin values in patients were lower than that in the control group (p &lt; 0.001). The values of D-dimer, fibrin/fibrinogen degradation products (FDP), and fibrinogen (FIB) in all SARS-CoV-2 cases were substantially higher than those in healthy controls. Moreover, D-dimer and FDP values in patients with severe SARS-CoV-2 infection were higher than those in patients with milder forms. Compared with healthy controls, prothrombin time activity (PT-act) was lower in SARS-CoV-2 patients. Thrombin time in critical SARS-CoV-2 patients was also shorter than that in controls.</jats:p></jats:sec><jats:sec id="j_cclm-2020-0188_s_996_w2aab3b7b4b1b6b1aab1c16b4Aa"><jats:title>Conclusions</jats:title><jats:p>The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.</jats:p></jats:sec>

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

“…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). Disease severity is variably associated with prolongation of the prothrombin time (PT) and international normalized ratio (INR) (1,20,26), and thrombin time (TT) (27), and variably by a trend toward shortened activated partial thromboplastin time (aPTT) (1,16,19,28).…”

Coagulopathy in COVID-19: Manifestations and management

“…7 The prothrombin time (PT) and activated partial thromboplastin time (aPTT) are only mildly prolonged, if at all, and platelet counts are usually normal or only mildly decreased (100 to 150 × 10 9 /L). [8][9][10] Elevated D-dimer levels on presentation with COVID-19 are associated with more severe disease (D-dimer greater than 0.5 μg/mL in 60% of patients with severe disease vs 43% with mild disease), 3 the need for ICU level of care, 11 and correlate with overall mortality. In a multivariable regression analysis of 191 patients, Zhou et al reported an odds ratio of death of 18.42 (2.64-128.55) for patients with a D-dimer > 1 μg/mL vs < 0.5 μg/mL on admission.…”

Recomendaciones sobre el tratamiento antitrombótico durante la pandemia COVID-19. Posicionamiento del Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología

“…Así, se ha descrito en estos pacientes una elevación del dímero D, que se asocia con un peor pronóstico e incluso predice la mortalidad 4,5 . Por lo tanto, se debe tener en cuenta una elevación de 2-3 veces el valor normal, incluso en presencia de síntomas leves 6,7 . Junto a ello, se ha detectado un discreto alargamiento del tiempo de protrombina en los pacientes con síntomas graves.…”