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Spotting the Clotting: Hypercoagulopathy in COVID-19

Severe COVID-19 illness can involve a spectrum of inflammation and unusual vascular disorders.

After reading this article, the learner will be able to:

  1. Delineate that COVID-19 is not just a disease that attacks the lungs, but one that can create widespread inflammation and hypercoagulability that can lead to significant multi-system organ damage;
  2. Explain why COVID-19 may be more of disease of blood vessels than the respiratory system and why lungs can still suffer as a result.
  3. Catalog the various complications of COVID-19 associated with hypercoagulable states, ranging from microinfarctions and blood clots in extremities and vital organs to outright brain injury and stroke;
  4. Recite why point coagulation profile testing, ranging from D-dimer assays and thromboelastography  (TEG) mapping, may help to target the appropriate patients for possible anti-coagulant therapy and also differentiate those who should not;
  5. Detail “10 Golden Considerations” for out-of-hospital health care providers with respect to identifying potential excessive clotting complications.

Resources

Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up. J Am Coll Cardiol, 2020 Apr 15 [epub ahead of print].

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel Coronavirus pneumonia. J Thromb Haemost, 2020 Apr 9 [epub ahead of print].

Fox SE, Akmatbekov A, Harbert JL, et al. Pulmonary and Cardiac Pathology in COVID-19: The First Autopsy Series From New Orleans. medRxiv, 2020 Apr 10; www.medrxiv.org/content/10.1101/2020.04.06.20050575v1.

Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med, 2020; 382: 1,708–20.

Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med, 2020 May 4 [epub ahead of print].

Johns Hopkins University & Medicine, Coronavirus Resource Center. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, https://coronavirus.jhu.edu/map.html.

Jones VG, Mills M, Suarez D, et al. COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. Hosp Pediatr, 2020 Apr 7 [epub head of print].

Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngology, 2020 Apr 6 [epub ahead of print].

Mao L, Wang M, Chen S, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. MedRXiv, 2020 Feb 25; www.medrxiv.org/content/10.1101/2020.02.22.20026500v1.

Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med, 2020 Apr 28; www.nejm.org/doi/full/10.1056/NEJMc2009787.

Panahi L, Amiri M, Pouy S. Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy; a Narrative Review. Arch Acad Emerg Med, 2020 Mar 23; 8(1): e34.

Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5,700 patients hospitalized with COVID-19 in the New York City area. JAMA, 2020 Apr 22.

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost, 2020; 18: 844–7. 

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost, 2020; 18: 1,094–9.

Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost, 2020 Mar 25 [epub ahead of print].

Wadman M, Couzin-Frankel J, Kaiser J, Matacic C. How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes. Science, 2020 Apr 17; www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes.

Wichmann D, Sperhake J, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med, 2020 May 6 [epub ahead of print].

  • Format
    Article
  • Duration
    .5
  • Credits
    .5
  • Cost
    $
    4.95