Abstract
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.
Highlights
The novel corona virus infection, originating in Wuhan, China, has rapidly spread worldwide [1]
Precise knowledge of the alteration of hemostatic parameters and the incidence of coagulopathy in severe COVID-19 patients is required to consider appropriate management, especially in patients admitted to the intensive care unit (ICU) who are at high risk for thrombotic complications
From March to May 2020, 24 consecutive patients were admitted to the ICU with the diagnosis of acute respiratory distress syndrome (ARDS) induced by COVID-19 and underwent mechanical ventilation
Summary
The novel corona virus infection (coronavirus disease 2019: COVID-19), originating in Wuhan, China, has rapidly spread worldwide [1]. Along with acute respiratory distress syndrome (ARDS), coagulation disorders are reported to be induced by severe COVID-19 pneumonia and to be associated with increased risk of death [2,3,4,5]. [6] Endothelial dysfunction and platelet activation induced by acute inflammation are ubiquitous in COVID-19-associated coagulopathy and might play key roles in the progression of organ ischemia and subsequent death [7]. In this context, several anticoagulant or thrombolytic agents are expected to be beneficial in the treatment of COVID-19 infections [8,9]. Local thrombus formation might be promoted in severe COVID-19
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