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COVID-19 and its implications for thrombosis and anticoagulation.

Publication ,  Journal Article
Connors, JM; Levy, JH
Published in: Blood
June 2020

Severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019 (COVID-19)-induced infection can be associated with a coagulopathy, findings consistent with infection-induced inflammatory changes as observed in patients with disseminated intravascular coagulopathy (DIC). The lack of prior immunity to COVID-19 has resulted in large numbers of infected patients across the globe and uncertainty regarding management of the complications that arise in the course of this viral illness. The lungs are the target organ for COVID-19; patients develop acute lung injury that can progress to respiratory failure, although multiorgan failure can also occur. The initial coagulopathy of COVID-19 presents with prominent elevation of D-dimer and fibrin/fibrinogen-degradation products, whereas abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon in initial presentations. Coagulation test screening, including the measurement of D-dimer and fibrinogen levels, is suggested. COVID-19-associated coagulopathy should be managed as it would be for any critically ill patient, following the established practice of using thromboembolic prophylaxis for critically ill hospitalized patients, and standard supportive care measures for those with sepsis-induced coagulopathy or DIC. Although D-dimer, sepsis physiology, and consumptive coagulopathy are indicators of mortality, current data do not suggest the use of full-intensity anticoagulation doses unless otherwise clinically indicated. Even though there is an associated coagulopathy with COVID-19, bleeding manifestations, even in those with DIC, have not been reported. If bleeding does occur, standard guidelines for the management of DIC and bleeding should be followed.

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Published In

Blood

DOI

EISSN

1528-0020

ISSN

0006-4971

Publication Date

June 2020

Volume

135

Issue

23

Start / End Page

2033 / 2040

Related Subject Headings

  • Venous Thromboembolism
  • Thrombosis
  • SARS-CoV-2
  • Pneumonia, Viral
  • Pandemics
  • Immunology
  • Humans
  • Fibrin Fibrinogen Degradation Products
  • Coronavirus Infections
  • COVID-19
 

Citation

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Connors, J. M., & Levy, J. H. (2020). COVID-19 and its implications for thrombosis and anticoagulation. Blood, 135(23), 2033–2040. https://doi.org/10.1182/blood.2020006000
Connors, Jean M., and Jerrold H. Levy. “COVID-19 and its implications for thrombosis and anticoagulation.Blood 135, no. 23 (June 2020): 2033–40. https://doi.org/10.1182/blood.2020006000.
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 Jun;135(23):2033–40.
Connors, Jean M., and Jerrold H. Levy. “COVID-19 and its implications for thrombosis and anticoagulation.Blood, vol. 135, no. 23, June 2020, pp. 2033–40. Epmc, doi:10.1182/blood.2020006000.
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 Jun;135(23):2033–2040.

Published In

Blood

DOI

EISSN

1528-0020

ISSN

0006-4971

Publication Date

June 2020

Volume

135

Issue

23

Start / End Page

2033 / 2040

Related Subject Headings

  • Venous Thromboembolism
  • Thrombosis
  • SARS-CoV-2
  • Pneumonia, Viral
  • Pandemics
  • Immunology
  • Humans
  • Fibrin Fibrinogen Degradation Products
  • Coronavirus Infections
  • COVID-19