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CC BY 4.0 · TH Open 2022; 06(01): e1-e9
DOI: 10.1055/s-0041-1742225
Original Article

Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection

Sarah Hadique 
1   Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, West Virginia University, Morgantown, West Virginia, United States
,
Varun Badami
1   Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, West Virginia University, Morgantown, West Virginia, United States
,
Rahul Sangani
1   Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, West Virginia University, Morgantown, West Virginia, United States
,
Michael Forte
1   Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, West Virginia University, Morgantown, West Virginia, United States
,
Talia Alexander
2   Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, United States
,
Aarti Goswami
3   Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, West Virginia, United States
,
Adriana Garrison
3   Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, West Virginia, United States
,
Sijin Wen
2   Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, United States
› Author Affiliations Funding Funding was received from WVCTSI (West Virginia Clinical and Transitional Sciences Institute). Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 2U54GM104942-03. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Objectives Thrombotic and bleeding complications are common in COVID-19 disease. In a prospective study, we performed a comprehensive panel of tests to predict the risk of bleeding and thrombosis in patients admitted with hypoxic respiratory failure due to severe COVID-19 infection.

Methods We performed a single center (step down and intensive care unit [ICU] at a quaternary care academic hospital) prospective study. Sequentially enrolled adult (≥18 years) patients were admitted with acute hypoxic respiratory failure due to COVID-19 between June 2020 and November 2020. Several laboratory markers of coagulopathy were tested after informed and written consent.

Results Thirty-three patients were enrolled. In addition to platelet counts, prothrombin time, and activated partial thromboplastin time, a series of protocol laboratories were collected within 24 hours of admission. These included Protein C, Protein S, Antithrombin III, ADAMTS13, fibrinogen, ferritin, haptoglobin, and peripheral Giemsa smear. Patients were then monitored for the development of hematological (thrombotic and bleeding) events and followed for 30 days after discharge. Twenty-four patients (73%) required ICU admissions. At least one laboratory abnormality was detected in 100% of study patients. Nine patients (27%) suffered from significant hematological events, and four patients had a clinically significant bleeding event requiring transfusion. No significant association was observed between abnormalities of coagulation parameters and the incidence of hematologic events. However, a higher SOFA score (10.89 ± 3.48 vs. 6.92 ± 4.10, p = 0.016) and CKD (5/9 [22.2%] vs. 2/24 [12.5%] p = 0.009) at baseline were associated with the development of hematologic events. 33.3% of patients died at 30 days. Mortality was similar in those with and without hematological events. Reduced ADAMTS13 level was significantly associated with mortality.

Conclusion Routine extensive testing of coagulation parameters did not predict the risk of bleeding and thrombosis in COVID-19 patients. Thrombotic and bleeding events in COVID-19 patients are not associated with a higher risk of mortality. Interestingly, renal dysfunction and a high SOFA score were found to be associated with increased risk of hematological events.

Keywords

COVID-19 - thrombosis - bleeding - ADAMTS-13 - 30-day mortality

Ethics statement

Ethics approval and consent to participate: The study protocol was approved by the institutional review board of WVU.


Consent for Publication

Not applicable.


Availability of Data and Material

All data generated or analyzed during this study are included in this published article.


Competing Interests

The authors declare they have no financial or non-financial competing interests.


Authors' Contributions

S.H. takes the responsibility of the content of the manuscript, including the data and analysis. S.H., R.S., V.B., M.F., S.W., and T.A. had full access to all of the data in the study and they take responsibility for the integrity of the data and the accuracy of the data analysis. S.H., R.S., V.B., and M.F. contributed substantially to the study design. S.H., R.S., V.B., M.F., A.G., and A.G. contributed toward the writing of manuscript. All authors have read and approved the manuscript.




Publication History

Received: 30 September 2021

Accepted: 19 November 2021

Article published online:
17 January 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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