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COVID-19-Associated Coagulopathy and Inflammatory Response: What Do We Know Already and What Are the Knowledge Gaps?
Klaus Görlinger1,2, Daniel Dirkmann1, Ajay Gandhi3
1From the Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Insights
COVID-19-associated coagulopathy increases thrombotic events and poor outcomes. Biomarkers and scoring systems aid prediction, but effective therapies are limited, prompting research into viscoelastic testing for guiding anticoagulation.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) frequently causes coagulopathy, leading to thrombotic events and adverse outcomes.
- Established biomarkers (coagulation, inflammation, immunity) and clinical scores (SOFA, ISTH DIC, SIC) help predict COVID-19 patient trajectories.
- Current therapeutic strategies for COVID-19 coagulopathy are largely supportive, highlighting a need for more targeted interventions.
Purpose of the Study:
- To summarize current knowledge on COVID-19-associated coagulopathy.
- To identify critical knowledge gaps regarding prediction and management.
- To explore the potential role of viscoelastic testing in managing COVID-19 coagulopathy.
Main Methods:
- Review of existing literature on COVID-19-associated coagulopathy.
- Analysis of biomarkers including D-dimer, fibrinogen, platelet count, interleukin-6, and lymphocyte count.
- Discussion of clinical scoring systems like SOFA, ISTH DIC, and SIC score.
- Consideration of ongoing research, such as the ROHOCO study, investigating viscoelastic testing (rotational thromboelastometry).
Main Results:
- Biomarkers and clinical scores are valuable for predicting clinical course, resource needs (ICU, ventilation, ECMO), and outcomes in COVID-19 patients.
- Therapeutic options for COVID-19 coagulopathy remain limited to supportive care.
- The utility of viscoelastic testing in predicting outcomes or guiding anticoagulation in COVID-19-associated coagulopathy requires further investigation.
Conclusions:
- COVID-19-associated coagulopathy presents a significant clinical challenge with limited treatment options.
- Further research is essential to elucidate the role of novel diagnostic tools like viscoelastic testing.
- Addressing knowledge gaps is crucial for improving patient outcomes and guiding anticoagulation strategies in COVID-19.
Abstract:
Patients with coronavirus disease 2019 (COVID-19) frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6), and immunity (such as lymphocyte count) as well as clinical scoring systems (such as sequential organ failure assessment [SOFA], International Society on Thrombosis and Hemostasis disseminated intravascular coagulation [ISTH DIC], and sepsis-induced coagulopathy [SIC] score) can be helpful in predicting clinical course, need for hospital resources (such as intensive care unit [ICU] beds, intubation and ventilator therapy, and extracorporeal membrane oxygenation [ECMO]) and patient's outcome in patients with COVID-19. However, therapeutic options are actually limited to unspecific supportive therapy. Whether viscoelastic testing can provide additional value in predicting clinical course, need for hospital resources and patient's outcome or in guiding anticoagulation in COVID-19-associated coagulopathy is still incompletely understood and currently under investigation (eg, in the rotational thromboelastometry analysis and standard coagulation tests in hospitalized patients with COVID-19 [ROHOCO] study). This article summarizes what we know already about COVID-19-associated coagulopathy and-perhaps even more importantly-characterizes important knowledge gaps.
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