Thrombosis in COVID-19 patients*

E.M.J. Marsman

Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands

*Weergave van bespreking tijdens Journal Club meeting van de afdelingen cardiologie van Amsterdam UMC en OLVG d.d. 7 april 2020

COVID-19 might be an independent risk for thrombosis and diffuse intravascular coagulation, apart from immobilization and sepsis.1

D-dimer and prothrombin time on hospital admission were significantly higher in COVID-19 patients at the ICU2 and in non-survivors.3

Retrospectively, treatment with low-dose heparin showed lower mortality only in patients with markedly elevated d-dimer (>3.0 μg/mL) or significant coagulopathy. This effect was not found in severe non-COVID pneumonia.4

After finding anti-viral effects of dipyridamole in vitro, Liu et al. reported higher discharge rates after two weeks in 12 patients treated with dipyridamole (58.4%) versus 10 control patients (40%).5

Thus, the ISTH (International Society of Thrombosis and Haemostasis) advises LMWH prophylaxis in almost all COVID-19 patients and advise considering hospital admission based upon elevated d-dimer. Whether higher doses of prophylactic heparin should be administered, is yet to be explored.

References

  1. Kaplan, David, T. Charles Casper, C. Gregory Elliott, et al. VTE Incidence and Risk Factors in Patients with Severe Sepsis and Septic Shock. Chest 2015;148 (5): 1224–30. https://doi.org/10.1378/chest.15-0287.
  2. Huang, Chaolin, Yeming Wang, et al. Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. The Lancet 2020;395 (10223): 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5.
  3. Tang, Ning, Dengju Li, Xiong Wang, Ziyong Sun. Abnormal Coagulation Parameters Are Associated with Poor Prognosis in Patients with Novel Coronavirus Pneumonia. Journal of Thrombosis and Haemostasis 2020;18 (4): 844–47. https://doi.org/10.1111/jth.14768.
  4. Yin, Shiyu, Ming Huang, Dengju Li, Ning Tang. Difference of Coagulation Features between Severe Pneumonia Induced by SARS-CoV2 and Non-SARS-CoV2. Journal of Thrombosis and Thrombolysis 2020;April, 1–4. https://doi.org/10.1007/s11239-020-02105-8.
  5. Xiaoyan Liu, Zhe Li, Shuai Liu, et al. Potential therapeutic effects of dipyridamole in the severely ill patients with COVID-19. Acta Pharm Sin B. 2020 Apr 20 doi: 10.1016/j.apsb.2020.04.008 [Epub ahead of print].