COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU

Runhui Zheng,Li Jiang,Jiaan Xia,Nanshan Zhong,Wei Zhang,Jing Zhou,Dingyu Zhang,Bin Song,Ming Zhong,Shiyue Li,Xia Zheng,Nanshan Chen,Chun Pan,Yin Xi,Xiaoqing Liu,Wenjuan Wu,Yimin Li,Xiaodan Luo,Yang Xu ,Ying Xian Pan ,Zhihua Lin ,Tan H ,Ling Sang

doi:10.1186/s40164-021-00202-9

Abstract

Background Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases.Methods We studied patients with proven COVID-19 disease in the intensive care unit of Jinyintan Hospital, Wuhan, China from 30 to 2019 to 31 March 2020.ResultsOf 180 patients, 89 (49.44 %) had died, 85 (47.22 %) had been discharged alive, and 6 (3.33 %) were still hospitalised by the end of data collection. A D-dimer concentration of > 0.5 mg/L on admission was significantly associated with 30 day mortality, and a D-dimer concentration of > 5 mg/L was found in a much higher proportion of non-survivors than survivors. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scoring systems were dichotomised as < 4 or ≥ 4 and < 5 or ≥ 5, respectively, and the mortality rate was significantly different between the two stratifications in both scoring systems. Enoxaparin was administered to 68 (37.78 %) patients for thromboembolic prophylaxis, and stratification by the D-dimer concentration and DIC score confirmed lower mortality in patients who received enoxaparin when the D-dimer concentration was > 2 than < 2 mg/L or DIC score was ≥ 5 than < 5. A low platelet count and low serum calcium concentration were also related to mortality.ConclusionsA D-dimer concentration of > 0.5 mg/L on admission is a risk factor for severe disease. A SIC score of > 4 and DIC score of > 5 may be used to predict mortality. Thromboembolic prophylaxis can reduce mortality only in patients with a D-dimer concentration of > 2 mg/L or DIC score of ≥ 5.

Highlights

Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities characterised by elevations in procoagulants, which are indicators of higher mortality
Anticoagulant treatment and outcomes are closely related to the sepsis-induced coagulopathy (SIC) score and D-dimer concentration; the SIC criteria established by the International Society on Thrombosis and Haemostasis (ISTH) is often used to guide anticoagulant therapy [5, 6]
We focused on patients with severe COVID-19 who were admitted to the intensive care unit (ICU)

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities characterised by elevations in procoagulants, which are indicators of higher mortality. In an analysis of patients with severe COVID-19 from Tang, stratification by the SIC score revealed lower mortality in patients treated with prophylactic doses of heparin [2]. Many centres support increased prophylactic doses of anticoagulants for ICU patients because of the increased incidence of thrombotic complications despite the use of systematic thrombosis prophylaxis [7]. Coagulopathy management including monitoring of coagulation changes, thromboembolic prophylaxis, and anticoagulant treatment is becoming increasingly more important, and coagulopathy guidelines are needed to optimise specific therapy and reduce mortality. Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases

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Results

Conclusion