[HTML][HTML] Hematological phenotype of COVID-19-induced coagulopathy: far from typical sepsis-induced coagulopathy

Y Umemura, K Yamakawa, T Kiguchi, T Nishida… - Journal of Clinical …, 2020 - mdpi.com
Y Umemura, K Yamakawa, T Kiguchi, T Nishida, M Kawada, S Fujimi
Journal of Clinical Medicine, 2020mdpi.com
Background: Blood coagulation disorders commonly occur with severe coronavirus disease
2019 (COVID-19). However, there is only limited evidence on differentiating the pattern of
the hemostatic parameters from those of typical sepsis-induced coagulopathy (SIC).
Methods: To elucidate the specific pattern of coagulopathy induced by COVID-19
pneumonia, this retrospective, observational study targeted consecutive adult patients with
COVID-19-induced acute respiratory distress syndrome (ARDS) and compared hemostatic …
Background
Blood coagulation disorders commonly occur with severe coronavirus disease 2019 (COVID-19). However, there is only limited evidence on differentiating the pattern of the hemostatic parameters from those of typical sepsis-induced coagulopathy (SIC).
Methods
To elucidate the specific pattern of coagulopathy induced by COVID-19 pneumonia, this retrospective, observational study targeted consecutive adult patients with COVID-19-induced acute respiratory distress syndrome (ARDS) and compared hemostatic biomarkers with non-COVID-19-induced septic ARDS. Multilevel mixed-effects regression analysis was performed and Kaplan–Meier failure curves were constructed.
Results
We enrolled 24 patients with COVID-19-induced ARDS and 200 patients with non-COVID-19-induced ARDS. Platelet count, antithrombin activity, and prothrombin time in the COVID-19 group were almost within normal range and time series alterations of these markers were significantly milder than the non-COVID-19 group (p = 0.052, 0.037, and 0.005, respectively). However, fibrin/fibrinogen degradation product and D-dimer were significantly higher in the COVID-19 group (p = 0.001, 0.002, respectively). COVID-19 patients had moderately high levels of thrombin–antithrombin complex and plasmin-alpha2-plasmin inhibitor complex but normal plasminogen activator inhibitor-1 level.
Conclusions
The hematological phenotype of COVID-19-induced coagulopathy is quite different from that in typical SIC characterized by systemic hypercoagulation and suppressed fibrinolysis. Instead, local thrombus formation might be promoted in severe COVID-19.
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