Evaluation of procoagulant & anticoagulant activity in COVID-19

ABSTRACT

Aims & Objectives: To study coagulation parameters and its effect on outcome in patients with COVID-19. Patients/Materials & Methods: It was an observational crosssectional study conducted in single tertiary hospital. The study was conducted on samples from 230 patients. All the patients were positive for SARS-CoV-2 by RT-PCR. Patients were categorized as asymptomatic, mild, moderate, or severe according to the guidelines published by the Ministry of Health and Family Welfare (MoHFW), Government of India and World Health Organisation. Following parameters were analysed for these patients- Prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, fibrinogen, factor-VIII, protein-C (PC), protein-S (PS) and antithrombin. Results: Our study conducted on 230 adults showed that there is increase in coagulation abnormalities with increase in severity of COVID-19. There is increase in pro-coagulant and anticoagulant activity with increase in severity of disease. 230 patients included 132 (57.4%) males and had mean age 51.82 ± 16.6 years. In this cohort, 61.3% of patients were either asymptomatic (34.3%) or had mild disease (27%), whereas 20% and 18.7% patients had moderate or severe disease, respectively. 12 (5.2%) and 26 (11.3%) patients had prolongation of PT and APTT, respectively. D-dimer levels increased with increasing disease severity and were significantly higher in nonsurvivors when compared to survivors (6.32 ± 7.62 vs 1.69 ± 3.8 lg/mL;p<0.0001). Mean levels of fibrinogen, PC, PS and antithrombin levels though remained in normal range but increased from asymptomatic to moderate disease. However, factor VIII showed significant increase in all stages. Discussion & Conclusion: Number of patients with abnormal procoagulant and anticoagulant parameters increased with increasing severity but didn't differ among survivor and non-survivors except PS. This study reveals age, D-dimer, APTT, fibrinogen and Factor VIII levels were significantly higher in patients with moderate and severe disease as compared to asymptomatic and mild disease.