Sars-CoV-2 Induced Coagulopathy and Prognosis in Hospitalized Patients: A Snapshot from Italy
It has been reported from China the presence of altered coagulation parameters in a significant proportion of hospitalized patients.   In addition, increased D-dimer (DD) levels have gained particular attention as predictors of acute respiratory distress syndrome development, the need of intensive care unit(ICU) admission, or death.  It is well known that DD is a highly nonspecific marker which may be only the mirror of the clotting activation following the inflammatory process.  Nevertheless, several thrombotic complications have been reported in patients with Covid-19 treated in ICU and the possible treatment with heparin appears to be very attractive.
Before this therapeutic application, it is mandatory to verify and report to the scientific community which is the trend of coagulation parameters, so that we can accumulate several observations useful to design ad hoc interventional trials.
In this scenario, we decided to analyze the routine coagulation parameters—prothrombin time (PT), activated partial thromboplastin time (aPTT), DD, and platelet count—of a consecutive series of patients with documented infection by Sars-Cov-2 hospitalized in Careggi Hospital, Florence, Italy.
Received: 14 April 2020
Accepted: 06 May 2020
26 May 2020 (online)
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72-314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; DOI: 10.1001/jama.2020.2648.
- 2 Istituto Superiore di Sanità. Characteristics of COVID-19 patients dying in Italy. Report based on available data on March 30th, 2020. Available at: https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-19_30_marzo_eng.pdf . Accessed April 1, 2020
- 3 Guan WJ, Ni ZY, Hu Y. , et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
- 4 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (04) 844-847
- 5 Huang C, Wang Y, Li X. , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497506
- 6 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (05) 1094-1099
- 7 Han H, Yang L, Liu R. , et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med 2020; 58 (07) 1116-1120
- 8 Rodelo JR, De la Rosa G, Valencia ML. , et al. D-dimer is a significant prognostic factor in patients with suspected infection and sepsis. Am J Emerg Med 2012; 30 (09) 1991-1999
- 9 Semeraro F, Ammollo CT, Caironi P. , et al. D-dimer corrected for thrombin and plasmin generation is a strong predictor of mortality in patients with sepsis. Blood Transfus 2019; 1-8
- 10 Li X, Ma X. The role of heparin in sepsis: much more than just an anticoagulant. Br J Haematol 2017; 179 (03) 389-398
- 11 Jackson SP, Darbousset R, Schoenwaelder SM. Thromboinflammation: challenges of therapeutically targeting coagulation and other host defense mechanisms. Blood 2019; 133 (09) 906-918
- 12 Iba T, Levy JH. Inflammation and thrombosis: roles of neutrophils, platelets and endothelial cells and their interactions in thrombus formation during sepsis. J Thromb Haemost 2018; 16 (02) 231-241
- 13 Claushuis TAM, de Stoppelaar SF, Stroo I. , et al. Thrombin contributes to protective immunity in pneumonia-derived sepsis via fibrin polymerization and platelet-neutrophil interactions. J Thromb Haemost 2017; 15 (04) 744-757
- 14 Burzynski LC, Humphry M, Pyrillou K. , et al. The coagulation and immune systems are directly linked through the activation of interleukin-1α by thrombin. Immunity 2019; 50 (04) 1033-1042
- 15 de Stoppelaar SF, van 't Veer C, van der Poll T. The role of platelets in sepsis. Thromb Haemost 2014; 112 (04) 666-677
- 16 Vardon-Bounes F, Ruiz S, Gratacap MP, Garcia C, Payrastre B, Minville V. Platelets are critical key players in sepsis. Int J Mol Sci 2019; 20 (14) E3494
- 17 Assinger A, Schrottmaier WC, Salzmann M, Rayes J. Platelets in sepsis: an update on experimental models and clinical data. Front Immunol 2019; 10: 1687
- 18 Gralinski LE, Bankhead III A, Jeng S. , et al. Mechanisms of severe acute respiratory syndrome coronavirus-induced acute lung injury. MBio 2013; 4 (04) e00271-e13
- 19 Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation?. Curr Pharm Des 2011; 17 (01) 47-58
- 20 Slavka G, Perkmann T, Haslacher H. , et al. Mean platelet volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. Arterioscler Thromb Vasc Biol 2011; 31 (05) 1215-1218