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.
- 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.
- 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.
- 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.
- 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.
- 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].