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COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection.
Al-Samkari, Hanny; Karp Leaf, Rebecca S; Dzik, Walter H; Carlson, Jonathan C T; Fogerty, Annemarie E; Waheed, Anem; Goodarzi, Katayoon; Bendapudi, Pavan K; Bornikova, Larissa; Gupta, Shruti; Leaf, David E; Kuter, David J; Rosovsky, Rachel P.
  • Al-Samkari H; Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
  • Karp Leaf RS; Harvard Medical School, Boston, MA; and.
  • Dzik WH; Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
  • Carlson JCT; Harvard Medical School, Boston, MA; and.
  • Fogerty AE; Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
  • Waheed A; Harvard Medical School, Boston, MA; and.
  • Goodarzi K; Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
  • Bendapudi PK; Harvard Medical School, Boston, MA; and.
  • Bornikova L; Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
  • Gupta S; Harvard Medical School, Boston, MA; and.
  • Leaf DE; Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
  • Kuter DJ; Harvard Medical School, Boston, MA; and.
  • Rosovsky RP; Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
Blood ; 136(4): 489-500, 2020 07 23.
Article in English | MEDLINE | ID: covidwho-704282
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Thrombosis / Blood Coagulation / Coronavirus Infections / Betacoronavirus / Hemorrhage Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Blood Year: 2020 Document Type: Article Affiliation country: Blood.2020006520

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Thrombosis / Blood Coagulation / Coronavirus Infections / Betacoronavirus / Hemorrhage Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Blood Year: 2020 Document Type: Article Affiliation country: Blood.2020006520