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Case Report: Asymptomatic COVID-19 patient with a subtle hypercoagulable state and fluctuating D-dimer level
Jefferson Caesario1, Decsa M Hertanto2, Kukuh D Hernugrahanto3
1Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia.
F1000Research
|March 7, 2022
Summary
Asymptomatic COVID-19 patients can silently develop dangerous blood clots. D-dimer monitoring is crucial, as decreasing levels do not guarantee the cessation of coagulopathy in these cases.
Area of Science:
- Internal Medicine
- Hematology
- Infectious Diseases
Background:
- COVID-19 is associated with coagulopathy, leading to diffuse blood clots and high mortality.
- D-dimer is a key marker for COVID-19-induced coagulopathy and fibrinolysis.
- Elevated D-dimer levels can indicate the initiation of a cytokine storm.
Observation:
- An asymptomatic patient presented with sudden D-dimer elevation.
- Initial heparin therapy normalized D-dimer, but it rebounded, accompanied by inflammatory markers (hs-CRP, ESR, IL-6) and hyperglycemia.
- SARS-CoV-2 PCR remained negative throughout the observation period.
Findings:
- Asymptomatic COVID-19 patients can experience silent coagulopathy.
- D-dimer rebound indicates a persistent or recurring coagulopathy despite initial treatment.
- Hyperglycemia and elevated inflammatory markers suggest a complex systemic response.
Implications:
- Continuous D-dimer monitoring is essential, even in asymptomatic COVID-19 patients.
- A decrease in D-dimer does not necessarily signify the resolution of coagulopathy.
- Further research is needed to understand and manage asymptomatic coagulopathy in COVID-19.
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