Update to coagulopathy in COVID-19: Manifestations and manag
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Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality. Critically ill patients without other risk factors for thrombosis can experience various thrombotic events, including microvascular thrombosis, venous and pulmonary thromboembolism, and acute arterial thrombosis.

Markedly elevated levels of D-dimer with normal fibrinogen levels are the hallmark laboratory findings of severe COVID-19 associated coagulopathy. Prophylaxis against venous thromboembolism is paramount for all hospitalized patients with COVID-19, with more aggressive prophylaxis and screening recommended for critically ill patients with D-dimer levels above 3.0 µg/mL. Point-of-care ultrasonography is the imaging method of choice for patients at high risk, as it entails minimal risk of exposing providers to the virus.

Key Recommendations:

-- Authors recommend measuring D-dimer, fibrinogen, prothrombin time, international normalized ratio, and activated partial thromboplastin time every 48 hours in hospitalized patients with COVID-19.

-- Prophylaxis against venous thromboembolism is recommended for all patients with COVID-19 on admission, using low-molecular-weight heparin, unfractionated heparin for those in renal failure, or fondaparinux for those with heparin-induced thrombocytopenia, even in the setting of thrombocytopenia as long as the platelet count is above 25 × 109/L.

-- Critically ill intensive care unit patients with D-dimer levels 3.0 µg/mL or higher should undergo screening with point-of-care ultrasonography and receive more intensive prophylaxis.

Source: https://www.ccjm.org/content/early/2020/12/14/ccjm.87a.ccc024-up
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