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. 2020 Dec;105(6):741-750.
doi: 10.1111/ejh.13501. Epub 2020 Aug 19.

COVID-19 coagulopathy: An in-depth analysis of the coagulation system

Reyes María Martín-Rojas  1 , Gloria Pérez-Rus  1   2 , Valeria Estefania Delgado-Pinos  1 , Amalia Domingo-González  1 , Isabel Regalado-Artamendi  1 , Natalia Alba-Urdiales  1 , Pablo Demelo-Rodríguez  2   3   4 , Silvia Monsalvo  1 , Gabriela Rodríguez-Macías  1 , Monica Ballesteros  1 , Santiago Osorio-Prendes  1 , José Luis Díez-Martín  1   2   3 , Cristina Pascual Izquierdo  1   2
Affiliations

COVID-19 coagulopathy: An in-depth analysis of the coagulation system

Reyes María Martín-Rojas et al. Eur J Haematol. 2020 Dec.

Abstract

Background: Abnormal coagulation parameters have been reported in COVID-19-infected patients. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been suggested to be a form of disseminated intravascular coagulation (DIC).

Objectives: The aim of our study was to analyze the coagulation parameters of patients with COVID-19, determine whether coagulation factors consumption occurs and identify potential prognostic biomarkers of the disease.

Patients/methods: Blood samples from hospitalized patients with COVID-19 pneumonia were collected. We performed basic coagulation tests and quantification of coagulation factors and physiological inhibitor proteins. Laboratory data were compared with clinical data and outcomes.

Results: The study involved 206 patients (63.6% male). D-dimer was particularly elevated (median 450 ng/mL; IQR 222.5-957.3). Free protein S levels were below the normal range (median 56.6%; IQR: 43.6-68.9), and factor VIII showed an increasing trend (median 173.4%; IQR: 144.1-214.9). However, all coagulation factors were within normal limits. We found no correlation between abnormal coagulation parameters and thrombosis, except for higher D-dimer (HR 1.99; 95% CI 1.3-3.1; P = .002).

Conclusions: COVID-19 is associated with coagulopathy that correlates with poor prognosis. However, we did not demonstrate a consumption of coagulation factors, as seen in DIC.

Keywords: COVID-19; D-dimer; SARS-CoV-2 infection; coagulation factors; coagulopathy.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Comparison of coagulation factors and physiological inhibitory proteins between survivors and non‐survivors. Lines represent median and Interquartile range. Factor II, VII and X levels were significantly lower in non‐survivors (P < .05). Free protein S was found to be below the normal range in our sample. There was a correlation between lower levels of Protein C (P = .001) and antithrombin (P = .008) and poor prognosis [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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