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COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection.
- Source :
-
Blood [Blood] 2020 Jul 23; Vol. 136 (4), pp. 489-500. - Publication Year :
- 2020
-
Abstract
- Patients with coronavirus disease 2019 (COVID-19) have elevated D-dimer levels. Early reports describe high venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) rates, but data are limited. This multicenter retrospective study describes the rate and severity of hemostatic and thrombotic complications of 400 hospital-admitted COVID-19 patients (144 critically ill) primarily receiving standard-dose prophylactic anticoagulation. Coagulation and inflammatory parameters were compared between patients with and without coagulation-associated complications. Multivariable logistic models examined the utility of these markers in predicting coagulation-associated complications, critical illness, and death. The radiographically confirmed VTE rate was 4.8% (95% confidence interval [CI], 2.9-7.3), and the overall thrombotic complication rate was 9.5% (95% CI, 6.8-12.8). The overall and major bleeding rates were 4.8% (95% CI, 2.9-7.3) and 2.3% (95% CI, 1.0-4.2), respectively. In the critically ill, radiographically confirmed VTE and major bleeding rates were 7.6% (95% CI, 3.9-13.3) and 5.6% (95% CI, 2.4-10.7), respectively. Elevated D-dimer at initial presentation was predictive of coagulation-associated complications during hospitalization (D-dimer >2500 ng/mL, adjusted odds ratio [OR] for thrombosis, 6.79 [95% CI, 2.39-19.30]; adjusted OR for bleeding, 3.56 [95% CI, 1.01-12.66]), critical illness, and death. Additional markers at initial presentation predictive of thrombosis during hospitalization included platelet count >450 × 109/L (adjusted OR, 3.56 [95% CI, 1.27-9.97]), C-reactive protein (CRP) >100 mg/L (adjusted OR, 2.71 [95% CI, 1.26-5.86]), and erythrocyte sedimentation rate (ESR) >40 mm/h (adjusted OR, 2.64 [95% CI, 1.07-6.51]). ESR, CRP, fibrinogen, ferritin, and procalcitonin were higher in patients with thrombotic complications than in those without. DIC, clinically relevant thrombocytopenia, and reduced fibrinogen were rare and were associated with significant bleeding manifestations. Given the observed bleeding rates, randomized trials are needed to determine any potential benefit of intensified anticoagulant prophylaxis in COVID-19 patients.<br /> (© 2020 by The American Society of Hematology.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Biomarkers blood
C-Reactive Protein metabolism
COVID-19
Coronavirus Infections diagnosis
Coronavirus Infections epidemiology
Coronavirus Infections therapy
Female
Fibrin Fibrinogen Degradation Products metabolism
Hemorrhage epidemiology
Hemorrhage therapy
Hospitalization
Humans
Male
Middle Aged
Pandemics
Platelet Count
Pneumonia, Viral diagnosis
Pneumonia, Viral epidemiology
Pneumonia, Viral therapy
SARS-CoV-2
Thrombosis epidemiology
Thrombosis therapy
Betacoronavirus metabolism
Blood Coagulation
Coronavirus Infections blood
Hemorrhage blood
Pneumonia, Viral blood
Thrombosis blood
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0020
- Volume :
- 136
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 32492712
- Full Text :
- https://doi.org/10.1182/blood.2020006520