Thromb Haemost 2021; 121(12): 1610-1621
DOI: 10.1055/a-1477-3829
Coagulation and Fibrinolysis

Platelet Count Rose While D-Dimer Levels Dropped as Deaths and Thrombosis Declined—An Observational Study on Anticoagulation Shift in COVID-19

1  Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2  Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden
,
Johanna Dehlsen Wersäll
2  Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden
,
Anna Warnqvist
3  Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
,
Maria Farm
1  Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2  Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden
,
Maria Magnusson
1  Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
4  Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
5  Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
,
Anders Oldner
6  Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
7  Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
,
Anna Ågren
1  Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
5  Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
8  Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
,
Jovan Antovic
1  Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2  Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden
,
Maria Bruzelius
1  Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
5  Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
9  Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
› Author Affiliations

Abstract

Background High levels of D-dimer and low platelet counts are associated with poor outcome in coronavirus disease 2019 (COVID-19). As anticoagulation appeared to improve survival, hospital-wide recommendations regarding higher doses of anticoagulation were implemented on April 9, 2020.

Objectives To investigate if trends in D-dimer levels and platelet counts were associated with death, thrombosis, and the shift in anticoagulation.

Methods Retrospective cohort study of 429 patients with COVID-19 at Karolinska University Hospital. Information on D-dimer levels and platelet counts was obtained from laboratory databases and clinical data from medical records.

Results Thirty-day mortality and thrombosis rates were 19% and 18%, respectively. Pulmonary embolism was common, 65/83 (78%). Increased D-dimer levels in the first week in hospital were significantly associated with death and thrombosis (odds ratio [OR]: 6.06; 95% confidence interval [CL]: 2.10–17.5 and 3.11; 95% CI: 1.20–8.10, respectively). If platelet count increased more than 35 × 109/L per day, the mortality and thrombotic risk decreased (OR: 0.16; 95% CI: 0.06–0.41, and OR: 0.36; 95% CI: 0.17–0.80). After implementation of updated hospital-wide recommendations, the daily mean significantly decreased regarding D-dimer levels while platelet counts rose; −1.93; 95% CI: −1.00–2.87 mg/L FEU (fibrinogen-equivalent unit) and 65; 95% CI: 54–76 ×109/L, and significant risk reductions for death and thrombosis were observed; OR: 0.48; 95% CI: 0.25–0.92 and 0.35; 95% CI: 0.17–0.72.

Conclusion In contrast to D-dimer levels, increase of platelet count over the first week in hospital was associated with improved survival and reduced thrombotic risk. The daily mean levels of D-dimer dropped while the platelet counts rose, coinciding with increased anticoagulation and a decline in thrombotic burden and mortality.

Author Contributions

A. Sjöström, J. Antovic, and M. Bruzelius designed the study. A. Sjöström and J. D. Wersäll collected the data. A. Sjöström, M. Bruzelius, and A. Warnqvist performed data analysis and interpretation. A. Sjöström and M. Bruzelius drafted the first version of the manuscript. All authors contributed to the text and critically reviewed the final version of the article and they approved it for publication.


Data Sharing

The data that support the findings of this study are available on reasonable request from the corresponding author.


Supplementary Material



Publication History

Received: 04 February 2021

Accepted: 07 April 2021

Publication Date:
08 April 2021 (online)

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