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Systemic Coagulopathy in Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Noppacharn Uaprasert1,2, Chatphatai Moonla2,3, Darintr Sosothikul4

  • 1Division of Hematology, Department of Medicine, Faculty of Medicine, 65103Chulalongkorn University and King Chulalongkorn Memorial Hospital, Pathumwan, Bangkok, Thailand.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|January 14, 2021
PubMed

Insights

Systemic coagulopathy, including disseminated intravascular coagulation (DIC) and sepsis-induced coagulopathy (SIC), was found in 7.1% of COVID-19 patients. Despite elevated D-dimer in most, this low rate may explain higher thrombosis risk in COVID-19.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coagulation activation is observed in Coronavirus Disease 2019 (COVID-19) patients.
  • The actual prevalence of systemic coagulopathy in COVID-19 is not well-established.

Purpose of the Study:

  • To determine the pooled prevalence of systemic coagulopathy in COVID-19 patients.
  • To analyze the prevalence of specific coagulopathies like DIC and SIC.

Main Methods:

  • Systematic review and meta-analysis of studies from PubMed, EMBASE, and Cochrane.
  • Inclusion of 5 studies with 1210 confirmed COVID-19 patients.
  • Random-effects model used for calculating pooled prevalences and 95% confidence intervals (CIs).

Main Results:

  • The pooled prevalence of systemic coagulopathy was 7.1% (95%CI: 3.2%, 15.3%).
  • Prevalence of DIC was 4.3% (95%CI: 1.7%, 10.4%) and SIC was 16.2% (95%CI: 9.3%, 26.8%).
  • Elevated D-dimer was prevalent in 84.6% (95%CI: 52.0%, 96.5%), while platelet counts and coagulation times were minimally affected.

Conclusions:

  • Systemic coagulopathy is relatively uncommon in COVID-19 patients.
  • The low incidence of systemic coagulopathy, despite frequent D-dimer elevation, may contribute to the higher risk of thrombosis over bleeding in COVID-19.

Keywords:
COVID-19disseminated intravascular coagulationmeta-analysissepsis-induced coagulopathysystemic coagulopathy

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