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Coagulopathy of Coronavirus Disease 2019.
Crit Care Med. 2020 09; 48(9):1358-1364.CC

Abstract

OBJECTIVES

Recent studies have reported a high prevalence of thrombotic events in coronavirus disease 2019. However, the significance of thromboembolic complications has not been widely appreciated. The purpose of this review is to provide current knowledge of this serious problem.

DESIGN

Narrative review.

DATA SOURCES

Online search of published medical literature through PubMed using the term "COVID-19," "SARS," "acute respiratory distress syndrome," "coronavirus," "coagulopathy," "thrombus," and "anticoagulants."

STUDY SELECTION AND DATA EXTRACTION

Articles were chosen for inclusion based on their relevance to coagulopathy and thrombosis in coronavirus disease 2019, and anticoagulant therapy. Reference lists were reviewed to identify additional relevant articles.

DATA SYNTHESIS

Coronavirus disease 2019 is associated with a strikingly high prevalence of coagulopathy and venous thromboembolism that may contribute to respiratory deterioration. Monitoring coagulation variables is important, as abnormal coagulation tests are related to adverse outcomes and may necessitate adjuvant antithrombotic interventions. In the initial phase of the infection, D-dimer and fibrinogen levels are increased, while activated partial prothrombin time, prothrombin time, and platelet counts are often relatively normal. Increased D-dimer levels three times the upper limit of normal may trigger screening for venous thromboembolism. In all hospitalized patients, thromboprophylaxis using low-molecular-weight heparin is currently recommended. The etiology of the procoagulant responses is complex and thought to be a result of specific interactions between host defense mechanisms and the coagulation system. Although the coagulopathy is reminiscent of disseminated intravascular coagulation and thrombotic microangiopathy, it has features that are markedly distinct from these entities.

CONCLUSIONS

Severe acute respiratory syndrome coronavirus 2/coronavirus disease 2019 frequently induces hypercoagulability with both microangiopathy and local thrombus formation, and a systemic coagulation defect that leads to large vessel thrombosis and major thromboembolic complications, including pulmonary embolism in critically ill hospitalized patients. D-dimers and fibrinogen levels should be monitored, and all hospitalized patients should undergo thromboembolism prophylaxis with an increase in therapeutic anticoagulation in certain clinical situations.

Authors+Show Affiliations

Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC.Department of Medicine and Cardio-metabolic Programme-NIHR UCLH/UCL BRC, University College London Hospitals NHS Foundation Trust, London, United Kingdom.Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32467443

Citation

Iba, Toshiaki, et al. "Coagulopathy of Coronavirus Disease 2019." Critical Care Medicine, vol. 48, no. 9, 2020, pp. 1358-1364.
Iba T, Levy JH, Levi M, et al. Coagulopathy of Coronavirus Disease 2019. Crit Care Med. 2020;48(9):1358-1364.
Iba, T., Levy, J. H., Levi, M., Connors, J. M., & Thachil, J. (2020). Coagulopathy of Coronavirus Disease 2019. Critical Care Medicine, 48(9), 1358-1364. https://doi.org/10.1097/CCM.0000000000004458
Iba T, et al. Coagulopathy of Coronavirus Disease 2019. Crit Care Med. 2020;48(9):1358-1364. PubMed PMID: 32467443.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coagulopathy of Coronavirus Disease 2019. AU - Iba,Toshiaki, AU - Levy,Jerrold H, AU - Levi,Marcel, AU - Connors,Jean Marie, AU - Thachil,Jecko, PY - 2020/5/30/pubmed PY - 2020/9/4/medline PY - 2020/5/30/entrez SP - 1358 EP - 1364 JF - Critical care medicine JO - Crit Care Med VL - 48 IS - 9 N2 - OBJECTIVES: Recent studies have reported a high prevalence of thrombotic events in coronavirus disease 2019. However, the significance of thromboembolic complications has not been widely appreciated. The purpose of this review is to provide current knowledge of this serious problem. DESIGN: Narrative review. DATA SOURCES: Online search of published medical literature through PubMed using the term "COVID-19," "SARS," "acute respiratory distress syndrome," "coronavirus," "coagulopathy," "thrombus," and "anticoagulants." STUDY SELECTION AND DATA EXTRACTION: Articles were chosen for inclusion based on their relevance to coagulopathy and thrombosis in coronavirus disease 2019, and anticoagulant therapy. Reference lists were reviewed to identify additional relevant articles. DATA SYNTHESIS: Coronavirus disease 2019 is associated with a strikingly high prevalence of coagulopathy and venous thromboembolism that may contribute to respiratory deterioration. Monitoring coagulation variables is important, as abnormal coagulation tests are related to adverse outcomes and may necessitate adjuvant antithrombotic interventions. In the initial phase of the infection, D-dimer and fibrinogen levels are increased, while activated partial prothrombin time, prothrombin time, and platelet counts are often relatively normal. Increased D-dimer levels three times the upper limit of normal may trigger screening for venous thromboembolism. In all hospitalized patients, thromboprophylaxis using low-molecular-weight heparin is currently recommended. The etiology of the procoagulant responses is complex and thought to be a result of specific interactions between host defense mechanisms and the coagulation system. Although the coagulopathy is reminiscent of disseminated intravascular coagulation and thrombotic microangiopathy, it has features that are markedly distinct from these entities. CONCLUSIONS: Severe acute respiratory syndrome coronavirus 2/coronavirus disease 2019 frequently induces hypercoagulability with both microangiopathy and local thrombus formation, and a systemic coagulation defect that leads to large vessel thrombosis and major thromboembolic complications, including pulmonary embolism in critically ill hospitalized patients. D-dimers and fibrinogen levels should be monitored, and all hospitalized patients should undergo thromboembolism prophylaxis with an increase in therapeutic anticoagulation in certain clinical situations. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/32467443/Coagulopathy_of_Coronavirus_Disease_2019_ L2 - https://dx.doi.org/10.1097/CCM.0000000000004458 DB - PRIME DP - Unbound Medicine ER -