Coagulopathy in COVID-19: Connecting the Dots Together
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus has spread quickly and become a public health emergency of global concern. Originating in the Wuhan district of China, which has reportedly been declared free of it now, the rest of the world continues to struggle with its severity and spread. While a lot of scientific publications and clinical data are available, newer clinical investigations and experiences continue to evolve, thereby depicting the dynamic nature of the disease and the knowledge around it. Researchers and clinical professionals continue to collect scientific information, clinical data, and evidence to help build a knowledge pool and guidance for the health care professionals to manage those affected with this pandemic disease. As significant and new data emerge, a lot of already available information gets confirmed and updated, while some of it also getting rejected or disapproved. In this article, we aim to put together the scientific and clinical information that is proven so far and the areas where more data or evidence is needed before a clear understanding can be achieved and guidance can be developed.
19 May 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223) 497-506
- 2 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223) 507-513
- 3 Simmons J, Pittet JF. The coagulopathy of acute sepsis. Curr Opin Anaesthesiol 2015; 28 (02) 227-236
- 4 Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat Microbiol 2020; 5 (04) 562-569
- 5 Stopsack KH, Mucci LA, Antonarakis ES, Nelson PS, Kantoff PW. TMPRSS2 and COVID-19: serendipity or opportunity for intervention?. Cancer Discov 2020; (e-pub ahead of print) DOI: 10.1158/2159-8290.CD-20-0451.
- 6 Hoffmann M, Kleine-Weber H, Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181 (02) 271-280.e8
- 7 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; (e-pub ahead of print) DOI: 10.1056/NEJMoa2002032.
- 8 Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; (e-pub ahead of print) DOI: 10.1007/s00134-020-05991-x.
- 9 Almeida GD, Porada CD, St Jeor S, Ascensao JL. Human cytomegalovirus alters interleukin-6 production by endothelial cells. Blood 1994; 83 (02) 370-376
- 10 Liu Q, Imaizumi T, Aizawa T. et al. Cytosolic sensors of viral RNA are involved in the production of interleukin-6 via toll-like receptor 3 signaling in human glomerular endothelial cells. Kidney Blood Press Res 2019; 44 (01) 62-71
- 11 Mogensen TH. Pathogen recognition and inflammatory signaling in innate immune defenses. Clin Microbiol Rev 2009; 22 (02) 240-273
- 12 Liu T, Zhang L, Joo D. et al. NF-κB signaling in inflammation. Signal Transduct Target Ther 2017; 2: 17023
- 13 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.1585.
- 14 Henry BM. COVID-19, ECMO, and lymphopenia: a word of caution. Lancet Respir Med 2020; 8 (04) e24
- 15 Ventura MT, Casciaro M, Gangemi S. Buquicchio R Immunosenescence in aging: between immune cells depletion and cytokines up-regulation. Clin Mol Allergy 2017; 15: 21
- 16 Frasca D, Blomberg BB. Inflammaging decreases adaptive and innate immune responses in mice and humans. Biogerontology 2016; 17 (01) 7-19
- 17 Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020; (e-pub ahead of print) DOI: 10.1002/jmv.25748.
- 18 Lin L, Lu L, Cao W, Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection-a review of immune changes in patients with viral pneumonia. Emerg Microbes Infect 2020; 9 (01) 727-732
- 19 Mei H, Hu Y. Characteristics, causes, diagnosis and treatment of coagulation dysfunction in patients with COVID-19 [in Chinese]. Zhonghua Xue Ye Xue Za Zhi 2020; 41 (00) E002
- 20 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229) 1054-1062
- 21 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; (e-pub ahead of print) DOI: 10.1515/cclm-2020-0188.
- 22 Klok FA, Kruip MJHA, van der Meer NJM. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; (e-pub ahead of print) DOI: 10.1016/j.thromres.2020.04.013.
- 23 Hunt B, Retter A, McClintock C. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. https://thrombosisuk.org/downloads/T&H%20and%20COVID.pdf. Accessed April 20, 2020
- 24 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; (e-pub ahead of print) DOI: 10.1111/jth.14817.
- 25 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
- 26 Jiang H, Liu L, Guo T. et al. Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy. Ann Hematol 2019; 98 (07) 1721-1732
- 27 Iba T, Levy JH, Warkentin TE, Thachil J, van der Poll T, Levi M. Scientific and Standardization Committee on DIC, and the Scientific and Standardization Committee on Perioperative and Critical Care of the International Society on Thrombosis and Haemostasis. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost 2019; 17 (11) 1989-1994
- 28 Magdi M, Rahil A. Severe immune thrombocytopenia complicated by intracerebral haemorrhage associated with coronavirus infection: a case report and literature review. Eur J Case Rep Intern Med 2019; 6 (07) 001155
- 29 CascellaM, RajnikM, CuomoA, et al. Features, Evaluation and Treatment Coronavirus (COVID-19). Treasure Island, FL: StatPearls Publishing; 2020
- 30 Gao Y, Li T, Han M. et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol 2020; (e-pub ahead of print) DOI: 10.1002/jmv.25770.
- 31 Thachil J, Tang N, Gando S. et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Throm Haemost 2020; (e-pub ahead of print) DOI: 10.1111/JTH.14810.
- 32 Chen G, Wu D, Guo W, et al. Clinical and immunologic features in severe and moderate forms of coronavirus disease 2019. MedRxiv 2020 (e-pub ahead of print)10.1101/2020.02.16.20023903
- 33 Wada H, Thachil J, Di Nisio M. et al. Scientific Standardization Committee on DIC of the International Society on Thrombosis Haemostasis Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost 2013; 11: 761-767
- 34 Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020; (e-pub ahead of print) DOI: 10.1515/cclm-2020-0198.
- 35 Song JC, Wang G, Zhang W. et al. People’s Liberation Army Professional Committee of Critical Care Medicine, Chinese Society on Thrombosis and Haemostasis. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res 2020; 7: 19