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COVID-19 coagulopathy: An in-depth analysis of the coagulation system.
Eur J Haematol. 2020 Dec; 105(6):741-750.EJ

Abstract

BACKGROUND

Abnormal coagulation parameters have been reported in COVID-19-infected patients. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been suggested to be a form of disseminated intravascular coagulation (DIC).

OBJECTIVES

The aim of our study was to analyze the coagulation parameters of patients with COVID-19, determine whether coagulation factors consumption occurs and identify potential prognostic biomarkers of the disease.

PATIENTS/METHODS

Blood samples from hospitalized patients with COVID-19 pneumonia were collected. We performed basic coagulation tests and quantification of coagulation factors and physiological inhibitor proteins. Laboratory data were compared with clinical data and outcomes.

RESULTS

The study involved 206 patients (63.6% male). D-dimer was particularly elevated (median 450 ng/mL; IQR 222.5-957.3). Free protein S levels were below the normal range (median 56.6%; IQR: 43.6-68.9), and factor VIII showed an increasing trend (median 173.4%; IQR: 144.1-214.9). However, all coagulation factors were within normal limits. We found no correlation between abnormal coagulation parameters and thrombosis, except for higher D-dimer (HR 1.99; 95% CI 1.3-3.1; P = .002).

CONCLUSIONS

COVID-19 is associated with coagulopathy that correlates with poor prognosis. However, we did not demonstrate a consumption of coagulation factors, as seen in DIC.

Authors+Show Affiliations

Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain. Universidad Complutense de Madrid, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Universidad Complutense de Madrid, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain. Venous Thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain. Universidad Complutense de Madrid, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.Department of Hematology, University General Hospital Gregorio Marañon, Madrid, Spain. Universidad Complutense de Madrid, Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32749010

Citation

Martín-Rojas, Reyes María, et al. "COVID-19 Coagulopathy: an In-depth Analysis of the Coagulation System." European Journal of Haematology, vol. 105, no. 6, 2020, pp. 741-750.
Martín-Rojas RM, Pérez-Rus G, Delgado-Pinos VE, et al. COVID-19 coagulopathy: An in-depth analysis of the coagulation system. Eur J Haematol. 2020;105(6):741-750.
Martín-Rojas, R. M., Pérez-Rus, G., Delgado-Pinos, V. E., Domingo-González, A., Regalado-Artamendi, I., Alba-Urdiales, N., Demelo-Rodríguez, P., Monsalvo, S., Rodríguez-Macías, G., Ballesteros, M., Osorio-Prendes, S., Díez-Martín, J. L., & Pascual Izquierdo, C. (2020). COVID-19 coagulopathy: An in-depth analysis of the coagulation system. European Journal of Haematology, 105(6), 741-750. https://doi.org/10.1111/ejh.13501
Martín-Rojas RM, et al. COVID-19 Coagulopathy: an In-depth Analysis of the Coagulation System. Eur J Haematol. 2020;105(6):741-750. PubMed PMID: 32749010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 coagulopathy: An in-depth analysis of the coagulation system. AU - Martín-Rojas,Reyes María, AU - Pérez-Rus,Gloria, AU - Delgado-Pinos,Valeria Estefania, AU - Domingo-González,Amalia, AU - Regalado-Artamendi,Isabel, AU - Alba-Urdiales,Natalia, AU - Demelo-Rodríguez,Pablo, AU - Monsalvo,Silvia, AU - Rodríguez-Macías,Gabriela, AU - Ballesteros,Monica, AU - Osorio-Prendes,Santiago, AU - Díez-Martín,José Luis, AU - Pascual Izquierdo,Cristina, Y1 - 2020/08/19/ PY - 2020/06/16/received PY - 2020/07/27/revised PY - 2020/07/28/accepted PY - 2020/8/5/pubmed PY - 2020/11/13/medline PY - 2020/8/5/entrez KW - COVID-19 KW - D-dimer KW - SARS-CoV-2 infection KW - coagulation factors KW - coagulopathy SP - 741 EP - 750 JF - European journal of haematology JO - Eur J Haematol VL - 105 IS - 6 N2 - BACKGROUND: Abnormal coagulation parameters have been reported in COVID-19-infected patients. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been suggested to be a form of disseminated intravascular coagulation (DIC). OBJECTIVES: The aim of our study was to analyze the coagulation parameters of patients with COVID-19, determine whether coagulation factors consumption occurs and identify potential prognostic biomarkers of the disease. PATIENTS/METHODS: Blood samples from hospitalized patients with COVID-19 pneumonia were collected. We performed basic coagulation tests and quantification of coagulation factors and physiological inhibitor proteins. Laboratory data were compared with clinical data and outcomes. RESULTS: The study involved 206 patients (63.6% male). D-dimer was particularly elevated (median 450 ng/mL; IQR 222.5-957.3). Free protein S levels were below the normal range (median 56.6%; IQR: 43.6-68.9), and factor VIII showed an increasing trend (median 173.4%; IQR: 144.1-214.9). However, all coagulation factors were within normal limits. We found no correlation between abnormal coagulation parameters and thrombosis, except for higher D-dimer (HR 1.99; 95% CI 1.3-3.1; P = .002). CONCLUSIONS: COVID-19 is associated with coagulopathy that correlates with poor prognosis. However, we did not demonstrate a consumption of coagulation factors, as seen in DIC. SN - 1600-0609 UR - https://www.unboundmedicine.com/medline/citation/32749010/COVID_19_coagulopathy:_An_in_depth_analysis_of_the_coagulation_system_ L2 - https://doi.org/10.1111/ejh.13501 DB - PRIME DP - Unbound Medicine ER -