Abstract
COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and other respiratory viral (non-CoV-2-RV) infections are associated with thrombotic complications. The differences in prothrombotic potential between SARS-CoV-2 and non-CoV-2-RV have not been well characterised. We compared the thrombotic rates between these two groups of patients directly and further delved into their coagulation profiles. In this single-center, retrospective cohort study, all consecutive COVID-19 and non-CoV-2-RV patients admitted between January 15th and April 10th 2020 were included. Coagulation parameters studied were prothrombin time and activated partial thromboplastin time and its associated clot waveform analysis (CWA) parameter, min1, min2 and max2. In the COVID-19 (n = 181) group there were two (1.0 event/1000-hospital-days) myocardial infarction events while one (1.8 event/1000-hospital-day) was reported in the non-CoV-2-RV (n = 165) group. These events occurred in patients who were severely ill. There were no venous thrombotic events. Coagulation parameters did not differ throughout the course of mild COVID-19. However, CWA parameters were significantly higher in severe COVID-19 compared with mild disease, suggesting hypercoagulability (min1: 6.48%/s vs 5.05%/s, P < 0.001; min2: 0.92%/s2 vs 0.74%/s2, P = 0.033). In conclusion, the thrombotic rates were low and did not differ between COVID-19 and non-CoV-2-RV patients. The hypercoagulability in COVID-19 is a highly dynamic process with the highest risk occurring when patients were most severely ill. Such changes in haemostasis could be detected by CWA. In our population, a more individualized thromboprophylaxis approach, considering clinical and laboratory factors, is preferred over universal pharmacological thromboprophylaxis for all hospitalized COVID-19 patients and such personalized approach warrants further research.
Highlights
COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and other respiratory viral infections are associated with thrombotic complications
Venous thrombotic events were defined as any venous thromboembolism including deep vein thrombosis, pulmonary embolism and thrombosis of other sites, which were objectively confirmed on radiological imaging after initial clinical suspicion by attending physicians
A total of 181 patients testing positive for SARS-CoV-2 and 165 patients positive for non-CoV-2-RV via reverse transcriptase polymerase chain reaction (rt-PCR) testing
Summary
COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and other respiratory viral (non-CoV-2-RV) infections are associated with thrombotic complications. The thrombotic manifestations in COVID-19 patients have led to both the American Society of Hematology (ASH)[8] and International Society on Thrombosis and Hemostasis (ISTH)[9] recommending that all hospitalized patients including the non-critically ill, receive venous thromboembolism (VTE) thromboprophylaxis with low molecular weight heparin (LMWH) or fondaparinux. It is uncertain if such recommendations should be universally adopted as there is significant heterogeneity in reported thrombotic rates as most studies were carried out on critically ill COVID-19 p atients[10]. We aimed to determine the thrombotic rates in consecutive COVID-19 patients compared to patients with non-CoV-2-RV infections and to evaluate the dynamic haemostatic changes in both groups of patients using global coagulation assays
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