COVID-19 coagulopathy: an in-depth analysis of the coagulation system

Link to article at PubMed

Eur J Haematol. 2020 Aug 4. doi: 10.1111/ejh.13501. Online ahead of print.


BACKGROUND: Abnormal coagulation parameters have been reported in COVID-19 patients. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been suggested to be a form of disseminated intravascular coagulation (DIC).

OBJECTIVES: The aim of our study was to analyze the coagulation parameters of patients with COVID-19, determine if coagulation factors consumption occurs and identify potential prognostic biomarkers of the disease.

PATIENTS/METHODS: Blood samples from hospitalized patients with COVID-19 pneumonia were collected. We performed basic coagulation tests and quantification of coagulation factors and physiological inhibitor proteins. Laboratory data were compared with clinical data and outcomes.

RESULTS: The study involved 206 patients (63.6% male). D-dimer was particularly elevated (median 450 ng/ml; IQR 222.5-957.3). Free protein S levels were below the normal range (median 56.6%; IQR: 43.6-68.9) and factor VIII showed an increasing trend (median 173.4%; IQR: 144.1-214.9). However, all coagulation factors were within normal limits. We found no correlation between abnormal coagulation parameters and thrombosis, except for higher D-dimer (HR 1.99; 95% CI 1.3-3.1; p=0.002).

CONCLUSIONS: COVID-19 is associated with coagulopathy that correlates with poor prognosis. However, we did not demonstrate a consumption of coagulation factors, as seen in DIC.

PMID:32749010 | DOI:10.1111/ejh.13501

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