tetano
Editor, Senior Moderator
J Thromb Haemost
. 2020 Jun 18.
doi: 10.1111/jth.14975. Online ahead of print.
Coagulopathy in COVID-19
Toshiaki Iba[SUP] 1 [/SUP], Jerrold H Levy[SUP] 2 [/SUP], Marcel Levi[SUP] 3 [/SUP], Jecko Thachil[SUP] 4 [/SUP]
Affiliations
Abstract
The COVID-19 pandemic has become an urgent issue in every country. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently seen in this cohort. Therefore, coagulation tests may be considered useful to discriminate severe cases of COVID-19. The clinical presentation of COVID-19-associated coagulopathy is organ dysfunction primarily, while hemorrhagic events are less frequent. Changes in hemostatic biomarkers represented by increase in D-dimer and fibrin/fibrinogen degradation products indicate the essence of coagulopathy is massive fibrin formation. In comparison with bacterial-sepsis-associated coagulopathy/DIC, prolongation of prothrombin time, and activated partial thromboplastin time, and decrease in antithrombin activity is less frequent and thrombocytopenia is relatively uncommon in COVID-19. The mechanisms of the coagulopathy are not fully elucidated, however. It is speculated that the dysregulated immune responses orchestrated by inflammatory cytokines, lymphocyte cell-death, hypoxia, and endothelial damage are involved. Bleeding tendency is uncommon, but the incidence of thrombosis in COVID-19 and the adequacy of current recommendations regarding standard venous thromboembolic dosing are uncertain.
Keywords: COVID-19; anticoagulant; coagulopathy; coronavirus; disseminated intravascular coagulation.
. 2020 Jun 18.
doi: 10.1111/jth.14975. Online ahead of print.
Coagulopathy in COVID-19
Toshiaki Iba[SUP] 1 [/SUP], Jerrold H Levy[SUP] 2 [/SUP], Marcel Levi[SUP] 3 [/SUP], Jecko Thachil[SUP] 4 [/SUP]
Affiliations
- PMID: 32558075
- DOI: 10.1111/jth.14975
Abstract
The COVID-19 pandemic has become an urgent issue in every country. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently seen in this cohort. Therefore, coagulation tests may be considered useful to discriminate severe cases of COVID-19. The clinical presentation of COVID-19-associated coagulopathy is organ dysfunction primarily, while hemorrhagic events are less frequent. Changes in hemostatic biomarkers represented by increase in D-dimer and fibrin/fibrinogen degradation products indicate the essence of coagulopathy is massive fibrin formation. In comparison with bacterial-sepsis-associated coagulopathy/DIC, prolongation of prothrombin time, and activated partial thromboplastin time, and decrease in antithrombin activity is less frequent and thrombocytopenia is relatively uncommon in COVID-19. The mechanisms of the coagulopathy are not fully elucidated, however. It is speculated that the dysregulated immune responses orchestrated by inflammatory cytokines, lymphocyte cell-death, hypoxia, and endothelial damage are involved. Bleeding tendency is uncommon, but the incidence of thrombosis in COVID-19 and the adequacy of current recommendations regarding standard venous thromboembolic dosing are uncertain.
Keywords: COVID-19; anticoagulant; coagulopathy; coronavirus; disseminated intravascular coagulation.