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Coagulopathy in COVID-19: Manifestations and management

Simon R Mucha1,2, Siddharth Dugar3,4, Keith McCrae5,6

  • 1Critical Care Medicine, Respiratory Institute, Cleveland Clinic.

Cleveland Clinic Journal of Medicine
|May 16, 2020
PubMed

Insights

Severe COVID-19 causes inflammation and blood clots. Patients with high D-dimer levels need aggressive prevention of venous thromboembolism and ultrasound screening.

Area of Science:

  • Medicine
  • Infectious Diseases
  • Hematology

Background:

  • Severe COVID-19 is linked to significant inflammation.
  • This inflammation increases the risk of thrombotic complications, raising morbidity and mortality rates.
  • Key laboratory findings include elevated D-dimer levels with normal fibrinogen in COVID-19-associated coagulopathy.

Purpose of the Study:

  • To highlight the importance of venous thromboembolism prophylaxis in hospitalized COVID-19 patients.
  • To recommend aggressive prophylaxis and screening for high-risk patients.
  • To identify optimal imaging for high-risk individuals.

Main Methods:

  • Review of laboratory findings in severe COVID-19.
  • Analysis of D-dimer levels as a risk indicator.
  • Evaluation of point-of-care ultrasonography for diagnosis.

Main Results:

  • Elevated D-dimer (>3.0 μg/mL) indicates a need for intensified venous thromboembolism prophylaxis and screening.
  • Point-of-care ultrasonography is identified as a safe and effective imaging choice for high-risk patients.
  • This approach minimizes healthcare provider exposure to the virus.

Conclusions:

  • Aggressive venous thromboembolism prophylaxis and screening are crucial for hospitalized COVID-19 patients with elevated D-dimer.
  • Point-of-care ultrasonography is the preferred diagnostic tool for high-risk patients due to safety and efficiency.
  • Management strategies should focus on mitigating thrombotic risks in severe COVID-19.

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