Page 252 - 2021_05-Haematologica-web

Letters to the Editor
Hemostatic alterations in COVID-19
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2),1,2 that, first identified in China, has spread glob- ally. A coagulopathy is common, particularly in patients admitted to intensive care units (ICU).3 Although contro- versial,4-6 high rates of venous thromboembolism (VTE) have also been reported.7 The International Society on Thrombosis and Haemostasis (ISTH) released a state- ment suggesting prophylactic low molecular weight heparin (LMWH).8 However, the optimal strategy for pro- phylaxis remains controversial,9 owing to limited knowl- edge on how COVID-19 affects hemostasis.
At the beginning of the pandemic, COVID-19 patients were reported to present with abnormalities mimicking the coagulopathies like disseminated intravascular coag- ulation (DIC) or sepsis induced coagulopathy (SIC).10 However, a more recent study in a small group of patients severe enough to be admitted to the ICU failed to confirm DIC, because patients presented with a marked increase of D-dimer but without hypofibrinogen- emia or thrombocytopenia, i.e., the hallmarks of DIC with consumption coagulopathy.3 Considering these con- troversial findings, we report the results obtained using an array of hemostasis measurements in COVID-19 patients, admitted first to the emergency room and then to different wards characterized by delivery of different
Table 1. Median (min-max) values of the hemostasis measurements in COVID-19 patients. Intensity of care
PT ratio
APTT ratio
Platelet count, nx109/L Fibrinogen, mg/dL
D Dimer, ng/mL
Factor II, U/dL
Factor VIII, U/dL Antithrombin, U/dL
Protein C, U/dL
Protein S free antigen, U/dL
VWF:Ag, U/dL VWF:RCo, U/dL VWF:RCo /Ag ratio FVIII/VWFAg ratio
Ferritin, mg/L
C-reactive protein, mg/dL
Low Intermediate High
Tests for DIC diagnosis
1.02 1.12 1.06 (0.85-1.33) (0.95-1.44) (0.96.133) 0.93 0.91 0.95 (0.79-1.22) (0.78-1,10) (0.78-1.15)
P
0.0037 0.66 0.1 0.061 0.009
0.24 0.014 0.43 0.057 0.13
0.00007 0.00015 0.34 0.06
0.017 0.0057
275 362 (138-480) (120-556) 344 471 (150-861) (285-830) 870 1347 (203-38,847) (525-6,910)
Pro- and anticoagulant factors
116 94 (65-140) (76-128) 208 223 (121-347) (109-423) 87 94 (61-133) (63-135) 120 126 (60-234) (72-210) 75 72 (38-98) (26-95)
Endothelial-derived factors
262 371 (90-577) (132-769) 210 303 (88-447) (129-539) 0.85 0.86 (0.65-1.02) (0.62-0.98) 0.81 0.61 (0.40-2.05) (0.32-1.00)
Inflammation markers
380 705 (32-1,587) (124-4,081) 1.00 3.32
(0.07-11.71) (0.19-18.3)
366 (80-584) 531 (224-1035) 2,217 (564-6,410)
104 (75-143) 302 (178-374) 100 (71-143) 143 (85-232) 84 (56-110)
466 (231-746) 383 (195-528) 0.81 (0.69-1.01) 0.65 (0.40-0.97)
788 (212-5,064) 5.05 (0.6-25.5)
1472
COVID-19: Coronavirus disease 2019; DIC: disseminated intravascular coagulation; PT: prothrombin time; APTT: partial thromboplastin time;VWF:AG: von Willebrand factor antigen;VWF:Rco: ristocetin cofactor activity; FII: factor II; FVIII: factor VIII.
haematologica | 2021; 106(5)