Thrombotic microangiopathy, DIC-syndrome and COVID-19: link with pregnancy prothrombotic state

Makatsariya, Alexander; Slukhanchuk, E. V.; Bitsadze, V. O.; Khizroeva, J. Kh.; Tretyakova, M. V.; Цибизова, В. И.; Elalamy, Ismaı̈l; Gris, Jean‐Christophe; Makatsariya, N. A.; Mashkova, Tamara

doi:10.1080/14767058.2020.1786811

Cited by 18 publications

(12 citation statements)

References 54 publications

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“…Disseminated intravascular coagulation (DIC), as identified by a diagnostic DIC score, was found in 15/21 (71.4%) patients with fatal outcome but only 1/162 (0.6%) survivors [ 4 ]. DIC potentially evolves from endothelial activation or endothelial damage triggered by SARS-CoV-2 infection and subsequent consumption of plasmatic coagulation factors during COVID-19 [ 17 , 18 , 19 ]. DIC causes microvascular thrombosis, subsequent tissue malperfusion, and eventually drives multi organ failure.…”

Section: Introductionmentioning

confidence: 99%

No Evidence for Classic Thrombotic Microangiopathy in COVID-19

Falter

Rossmann

Menge

et al. 2021

JCM

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Background: Coronavirus disease-2019 (COVID-19) triggers systemic infection with involvement of the respiratory tract. There are some patients developing haemostatic abnormalities during their infection with a considerably increased risk of death. Materials and Methods: Patients (n = 85) with SARS-CoV-2 infection attending the University Medical Center, Mainz, from 3 March to 15 May 2020 were retrospectively included in this study. Data regarding demography, clinical features, treatment and laboratory parameters were analyzed. Twenty patients were excluded for assessment of disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) due to lack of laboratory data. Results: COVID-19 patients (n = 65) were investigated, 19 with uncomplicated, 29 with complicated, and 17 with critical course; nine (13.8%) died. Seven patients showed overt DIC according to the ISTH criteria. The fibrinogen levels dropped significantly in these patients, although not below 100 mg/dl. Hallmarks of TMA, such as thrombocytopenia and microangiopathic haemolytic anaemia, were not detected in any of our COVID-19 patients. ADAMTS13 activity was mildly to moderately reduced in 4/22 patients, all having strongly elevated procalcitonin levels. Conclusion: DIC occurred in 7/65 COVID-19 patients but fibrinogen and platelet consumption were compensated in almost all. ADAMTS13 assays excluded TTP and hallmarks of classic TMA were absent in all investigated patients. We hypothesize that the lacking erythrocyte fragmentation and only mild platelet consumption in severe COVID-19 are due to a microangiopathy predominantly localized to the alveolar microcirculation with a low blood pressure gradient.

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Section: Introductionmentioning

confidence: 99%

No Evidence for Classic Thrombotic Microangiopathy in COVID-19

Falter

Rossmann

Menge

et al. 2021

JCM

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“…Segundo Makatsariya et al (2020), uma mulher grávida passa por diversas transformações durante a gestação, principalmente quando se remete ao sistema cardiovascular, onde temos mudanças como hipercoagulação fisiológica, retardamento do fluxo venoso, aumento da capacitância venosa, entre outras, sendo todas importantes para precaver hemorragia no parto. No entanto, tais mudanças favorecem o risco de tromboembolismo venoso em até 5 a 6 vezes mais que o normal, e é por isso que existe o sistema compensatório que através de mecanismos particulares irão manter o equilíbrio, isso quando se fala de uma gravidez normal e saudável.…”

Section: Resultsunclassified

“…Porém, ressalta-se que a coagulopatia associada à COVID-19 não foi totalmente descrita no momento de apresentação no início da pandemia e a literatura sugere, para a população não grávida, um possível componente pró-trombogênico associado à COVID-19. Desse modo, essa doença se relaciona com distúrbios de coagulação tanto para gestantes, quanto para a população geral (Makatsariya et al, 2020).…”

Section: Resultsunclassified

Coagulopatia em gestantes com COVID-19

Santos

Araújo

Telis

et al. 2021

RSD

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A atual pandemia da COVID-19, causada pelo novo coronavírus SARSCoV-2, teve rápida disseminação e resultou em inúmeros casos fatais. A coagulopatia é uma das principais complicações dessa doença, sendo possível a ocorrência em qualquer paciente infectado pelo vírus; um dos grupos de risco, as pacientes obstétricas, requer maior atenção, devido às alterações coagulativas e hemostáticas já esperadas neste grupo. O objetivo da revisão foi realizar um levantamento bibliográfico de artigos que abordam a relação entre hipercoagulopatia e gestantes infectadas pelo vírus SARS-COV-2. A pesquisa foi efetuada nas bases de dados Google Acadêmico, Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (Scielo) e PubMed. Foram utilizados os seguintes descritores “gestantes”, “coagulopatia”, “doença sanguínea”, “COVID-19”, “alterações hematológicas”. Alterações de coagulação ocorrem em pacientes gestantes ou não infectadas pelo SARS-COV-2. As gestantes são um grupo mais susceptível à agravos, devido ao processo de hipercoagulabilidade que já ocorre naturalmente no período gestacional. Faz-se necessário mais estudos que evidenciem essa associação, a fim de prover os cuidados e atendimento adequados a tais pacientes.

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“…(Makatsariya et al, 2020) provide a useful overview of microangiopathy. They note that thrombotic microangiopathy is divided into primary and secondary.…”

Section: Resultsmentioning

confidence: 99%

Characterising COVID-19 as a Viral Clotting Fever: A Mixed Methods Scoping Review

Marley

2020

Preprint

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BackgroundThe COVID-19 pandemic has claimed over 1 million lives globally and results from the SARS-COV2 virus. COVID-19 is associated with a coagulopathy. In this mixed-methods PRISMA-compliant scoping review, we set out to determine if ARDS, sepsis and DIC could account for the coagulopathy and if there were any other features of the coagulopathy we could determine so as to inform future research. Methods: We used a search strategy to identify papers with clinically relevant thromboembolic events in COVID-19. We then developed a technique referred to as an Abridged Thematic Analysis (ATA) to quickly identify themes in the papers so as to increase the yield of clinically relevant information. We further developed Validated Abridged Thematic Analysis (VATA) to validate the resulting taxonomy of themes. Finally we developed a number of methods that can be used by other researchers to take forwards this work. Results: We identified 56 studies with 10,523 patients, 456 patients with COVID-19 and thromboembolic events (TBE’s) and 586 thrombembolic events. There were an average of 1.3 TBE’s per patient. There were five main arterial territories with corresponding clinical sequelae: Acute limb ischaemia, myocardial infarcts, strokes, mesenteric ischaemia and pulmonary embolism. We also identified DVT’s. There were two further groups: medical-device-related coagulopathy and dermal lesions. In a subgroup of 119 patients we found mortality ranged from 26% in DVT to 79% in acute limb ischaemia although there was evidence of selection bias in the latter group. All patients were hospitalised and the average age of survivors was 63 versus 73 for those who died. 91/150 patients with TE’s had fever. From the ATA, we identified 16 characteristics of the clotting pathology in COVID-19. From the VATA, we identified 34 mechanisms leading to coagulopathy and grouped them according to Virchow’s triad of vascular damage, stasis and hypercoagulability. Coagulopathy occurred with and without each of ARDS, Sepsis and DIC. We conclude that COVID-19 leads to the syndrome of a viral clotting fever in a subgroup of patients and that the presentation of coagulopathy and fever should raise the possibility of COVID-19 as a differential. We make recommendations for future research studies.

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Thrombotic microangiopathy, DIC-syndrome and COVID-19: link with pregnancy prothrombotic state

Cited by 18 publications

References 54 publications

No Evidence for Classic Thrombotic Microangiopathy in COVID-19

No Evidence for Classic Thrombotic Microangiopathy in COVID-19

Coagulopatia em gestantes com COVID-19

Characterising COVID-19 as a Viral Clotting Fever: A Mixed Methods Scoping Review

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