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Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128245


Background: Males and females are similarly susceptible to COVID-19 infection. Multiple studies report male mortality rate to be nearly double that of females. Hypercoagulability is common in severe COVID-19 patients. D-dimer was reported as a significant marker for disease severity and mortality risk. It is unclear whether D-dimer levels differ between males and females. The effect of D-dimers on disease outcomes remains under investigation. Aim(s): To evaluate the sex difference of D-dimer level in hospitalized COVID-19 patients and to determine the effect of sex on disease outcomes. Method(s): We searched EMBASE for articles published prior to October 1, 2021, evaluating D-dimer in adult males and females, hospitalized for COVID-19 and reporting on mortality, ICU admission, hospital stay and thrombotic complications. 3225 articles were retrieved. Comparative, observational prospective or retrospective, or case control studies were included. Studies including pregnancy, children, or a secondary disease focus were excluded. We meta-analysed data from 10 included studies using Cochrane RevMan 5 software. Result(s): Of 11,827 hospitalized COVID-19+ adults, 6519 (55%) were male and 5308 (45%) were female. Critical illness was experienced by 1681 (26%) males and 1228 (23%) females. Mortality occurred in 877 (13%) males and 548 (10%) females. In unadjusted analysis males had higher odds of experiencing critical illness and mortality. The Odds Ratios were 1.53 [95% CI: 1.36-1.72, I2 = 77%, p =< 0.00001] and 1.40 [95% CI: 1.24-1.57, I2 = 0%, p =< 0.00001], respectively. The mean difference between male and female D-dimer level was 0.18 [95% CI: 0.13-0.23, I2 = 83%, p =< 0.00001]. The reporting of D-dimer assay calibration was inconsistent and D-dimer unit magnitude varied greatly between studies. Conclusion(s): Males have higher mean D-dimer levels and are at higher risk of experiencing poor COVID-19 outcomes than females. The diversity in D-dimer reporting among different studies can impact data interpretation. (Table Presented).

Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128101


Background: COVID-19 pandemic has evolved dramatically over the past 2 years and literature on COVID coagulopathy has been overwhelming. Understanding literature and assessing the quality of data available is a challenge which is furthermore complicated by the difficulty in defining the 'waves of infection' across the globe. Aim(s): To provide highlights on literature regarding coagulation impairments, thrombotic complications, and anticoagulation use in severe COVID-19 patients, over the past 2 years of the pandemic. Method(s): Performed a systematic search on MEDLINE, EMBASE and EPUB Ahead of Print AND Other Non-Indexed Citations (from inception to 18th July 2021). Studies were eligible for inclusion if written in English, reporting severe COVID-19/ hospitalized patients and reporting coagulopathy data and thrombotic complications. Articles had to be published in journals with impact factor 3 or above. Data ed on country, total number of patients, age and sex, coagulation parameters, thrombotic complications, and anticoagulation data. Result(s): Identified 62 studies (PRISMA in Figure 1). A total of 18,581 patients reported from 16 different countries (Figure 2) published between March 2020 to July 2021 were included in this review. Coagulation lab parameters were reported in most studies with considerable heterogeneity on data reported. A key finding is a pro-coagulant profile with hypercoagulability more pronounced in ICU patients. Controversy existed around thrombocytopenia in association with severe or late disease. Elevated fibrinogen was reported in 37/41 (90%) studies. Elevated D-dimer was consistently reported and was predictive of thrombosis and poor outcome. 46 (74%) studies reported VTE which occurred despite guideline-recommended thromboprophylaxis. Anticoagulation was reported in all studies, but practices were diverse. Conclusion(s): Evident heterogeneity of clinical and laboratory findings of reported studies with inconsistent reporting on coagulation parameters, units of measurement and relationship to disease outcomes. This study can help investigators carefully design future studies related to coagulopathy in COVID-19. (Figure Presented).