Login Register Cart 0
Generic placeholder image

Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

COVID-19-associated Coagulopathy and Thromboembolism: Determination of Their Patterns and Risk Factors as Predictors of Mortality Among Severe COVID-19 Patients

Author(s): Iftikhar Haider Naqvi*, Muhammad Tanveer Alam, Muhammad Rehan, Khalid Mahmood, Muhammad Aurangzeb and Abu Talib

Volume 20, Issue 1, 2022

Published on: 14 October, 2021

Page: [77 - 86] Pages: 10

DOI: 10.2174/1570161119666211014162409

Price: $65

Open Access Journals Promotions 2
Abstract

Background: Coronavirus Disease 2019 (COVID-19) is associated with Coagulopathy (CAC) and Venous Thromboembolism (VTE). These are well-reported complications of COVID-19 infection. Earlier publications have shown that CAC and thromboembolism are predictors of mortality among COVID-19 patients with severe disease.

Materials and Methods: A prospective study was conducted in the Intensive Care Unit (ICU) where all confirmed COVID-19 patients were enrolled and followed until death or ICU discharge. CAC, VTE, along with all comorbidities, were recorded. Predictors of mortality were determined by univariate and multivariate regression.

Results: Among 261 patients with COVID-19, 48.3% survived and 51.7% died. CAC was present in 53.2% and 76.3% of the survivors and non-survivors, respectively (p<0.001); 89 patients (31.4%) had VTE (p=0.36) and 11 patients (4.2%) had arterial thrombosis (p=0.76) among survivors and nonsurvivors. Age between 71-80 years (p=0.009), male gender (p=0.045), CAC (p<0.001), comorbidities like chronic kidney disease (CKD, p=0.013), chronic obstructive pulmonary disease (COPD, p=0.001) and asthma (p=0.046), were significant predictors of mortality.

Conclusion: A severe complication of COVID-19 is CAC, such as sepsis-induced coagulopathy, overt disseminated-coagulopathy and VTE. Old age, various comorbidities (e.g., COPD, CKD, or asthma), CAC, VTE (pulmonary embolism) and coagulation parameters with critical severity score (D-dimers, platelets, prothrombin time) and the SOFA (Sequential Organ Failure Assessment) score were significant predictors of mortality among COVID-19 patients.

Keywords: Venous thromboembolism, COVID-19-associated coagulopathy, sepsis-induced coagulopathy, overt disseminated intravascular coagulation, mortality, COPD.

« Previous Next »
[1]
WHO Corona Virus Disease (COVID-19) dashboard: Data last updated: 2021/4/20. 2021. Available from: https://covid19.who.int/?gclid=EAIaIQobChMIqcqkrIeL8AIVjqztCh3jfwFHEAAYASACEgKxfvD_BwE (Accessed on April, 20 ,2021).
[2]
Fehr AR, Perlman S. Coronaviruses: An overview of their replication and pathogenesis. Methods Mol Biol 2015; 1282: 1-23.
[http://dx.doi.org/10.1007/978-1-4939-2438-7_1] [PMID: 25720466]
[3]
Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J Med Virol 2020; 92(4): 418-23.
[http://dx.doi.org/10.1002/jmv.25681] [PMID: 31967327]
[4]
Glass WG, Subbarao K, Murphy B, Murphy PM. Mechanisms of host defense following severe acute respiratory syndrome-coronavirus (SARS-CoV) pulmonary infection of mice. J Immunol 2004; 173(6): 4030-9.
[http://dx.doi.org/10.4049/jimmunol.173.6.4030] [PMID: 15356152]
[5]
Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 2020; 382(21): 2049-55.
[http://dx.doi.org/10.1056/NEJMsb2005114] [PMID: 32202722]
[6]
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(4): 844-7.
[http://dx.doi.org/10.1111/jth.14768] [PMID: 32073213]
[7]
Iba T, Levy JH, Thachil J, Wada H, Levi M. The progression from coagulopathy to disseminated intravascular coagulation in representative underlying diseases. Thromb Res 2019; 179: 11-4.
[http://dx.doi.org/10.1016/j.thromres.2019.04.030] [PMID: 31059996]
[8]
Iba T, Levy JH, Wada H, Thachil J, Warkentin TE, Levi M. Differential diagnoses for sepsis-induced disseminated intravascular coagulation: Communication from the SSC of the ISTH. J Thromb Haemost 2019; 17(2): 415-9.
[http://dx.doi.org/10.1111/jth.14354] [PMID: 30618150]
[9]
Woei-A-Jin FJ, van der Starre WE, Tesselaar ME, et al. Procoagulant tissue factor activity on microparticles is associated with disease severity and bacteremia in febrile urinary tract infections. Thromb Res 2014; 133(5): 799-803.
[http://dx.doi.org/10.1016/j.thromres.2014.03.007] [PMID: 24657035]
[10]
Gould TJ, Lysov Z, Swystun LL, et al. Extracellular histones increase tissue factor activity and enhance thrombin generation by human blood monocytes. Shock 2016; 46(6): 655-62.
[http://dx.doi.org/10.1097/SHK.0000000000000680] [PMID: 27405066]
[11]
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135(23): 2033-40.
[http://dx.doi.org/10.1182/blood.2020006000] [PMID: 32339221]
[12]
American Society of Haematology: COVID-19 and VTE/ Anticoagulation. 2021. Available from https://www.hematology. org/COVID-19/COVID-19-and-vte-anticoagulation (Accessed on April, 16, 2021).
[13]
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020; 395(10223): 507-13.
[http://dx.doi.org/10.1016/S0140-6736(20)30211-7] [PMID: 32007143]
[14]
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061-9.
[http://dx.doi.org/10.1001/jama.2020.1585] [PMID: 32031570]
[15]
Luo W, Yu H, Gou J, et al. Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19). Preprints 2020; p. 2020020407.
[16]
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020; 395(10229): 1054-62.
[http://dx.doi.org/10.1016/S0140-6736(20)30566-3] [PMID: 32171076]
[17]
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; 46(6): 1089-98.
[http://dx.doi.org/10.1007/s00134-020-06062-x] [PMID: 32367170]
[18]
Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145-7.
[http://dx.doi.org/10.1016/j.thromres.2020.04.013] [PMID: 32291094]
[19]
Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York city health system. JAMA 2020; 324(8): 799-801.
[http://dx.doi.org/10.1001/jama.2020.13372] [PMID: 32702090]
[20]
Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost 2020; 18(6): 1324-9.
[http://dx.doi.org/10.1111/jth.14859] [PMID: 32306492]
[21]
COVID-19 treatment guidelines: Antithrombotic therapy in patients with COVID-19. Available from: https://www.covid19treatmentguidelines.nih.gov/antithrombotic-therapy/ Accessed on 16 May 2020.
[22]
World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: Interim guidance. Available from https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-whennovel-coronavirus-(ncov)-infection-is-suspected (Accessed January 31, 2020).
[23]
Clinical management guidelines for COVID-19 infections. Government of Pakistan. Ministry of national health services. Available from: https://storage.covid.gov.pk/new_guidelines/11December2020_20201211_Clinical_Management_Guidelines_for_COVID-19_infec (Accessed: April 25, 2021).
[24]
Iba T, Nisio MD, Levy JH, Kitamura N, Thachil J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: A retrospective analysis of a nationwide survey. BMJ Open 2017; 7(9)e017046
[http://dx.doi.org/10.1136/bmjopen-2017-017046] [PMID: 28963294]
[25]
Iba T, Levy JH, Raj A, Warkentin TE. Advance in the management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Clin Med 2019; 8(5): 728.
[http://dx.doi.org/10.3390/jcm8050728] [PMID: 31121897]
[26]
Baqi S, Naz A, Sayeed MA, et al. Clinical characteristics and outcome of patients with severe COVID-19 pneumonia at a public sector hospital in Karachi, Pakistan. Cureus 2021; 13(2)e13107
[http://dx.doi.org/10.7759/cureus.13107] [PMID: 33728127]
[27]
Sarfaraz S, Shaikh Q, Saleem SG, et al. Determinants of in-hospital mortality in COVID-19; A prospective cohort study from Pakistan. medRxiv. Available from: https://www.medrxiv.org/content/10.1101/2020.12.28.20248920v1#:~:text=A%20prospective%20cohort%20study%20was,%25%20(67%2F186).http://dx.doi.org/10.1101/2020.12.28.20248920
[28]
Piroth L, Cottenet J, Mariet AS, et al. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: A nationwide, population-based retrospective cohort study. Lancet Respir Med 2021; 9(3): 251-9.
[http://dx.doi.org/10.1016/S2213-2600(20)30527-0] [PMID: 33341155]
[29]
Cho SI, Yoon S, Lee HJ. Impact of comorbidity burden on mortality in patients with COVID-19 using the Korean health insurance database. Sci Rep 2021; 11(1): 6375.
[http://dx.doi.org/10.1038/s41598-021-85813-2] [PMID: 33737679]
[30]
Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of sex, age, and comorbidities with mortality in COVID-19 patients: A systematic review and meta-analysis. Intervirology 2020; 1-12.
[http://dx.doi.org/10.1159/000512592] [PMID: 33296901]
[31]
Zheng R, Zhou J, Song B, et al. COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU. Exp Hematol Oncol 2021; 10(1): 6.
[http://dx.doi.org/10.1186/s40164-021-00202-9] [PMID: 33522958]
[32]
Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020; 18(8): 1995-2002.
[http://dx.doi.org/10.1111/jth.14888] [PMID: 32369666]
[33]
Porfidia A, Valeriani E, Pola R, Porreca E, Rutjes AWS, Di Nisio M. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thromb Res 2020; 196: 67-74.
[http://dx.doi.org/10.1016/j.thromres.2020.08.020] [PMID: 32853978]
[34]
Potere N, Valeriani E, Candeloro M, et al. Acute complications and mortality in hospitalized patients with coronavirus disease 2019: A systematic review and meta-analysis. Crit Care 2020; 24(1): 389.
[http://dx.doi.org/10.1186/s13054-020-03022-1] [PMID: 32616077]
[35]
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; 18(6): 1421-4.
[http://dx.doi.org/10.1111/jth.14830] [PMID: 32271988]
[36]
Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine 2020; 29100639
[http://dx.doi.org/10.1016/j.eclinm.2020.100639] [PMID: 33251499]
[37]
Scudiero F, Silverio A, Di Maio M, et al. Pulmonary embolism in COVID-19 patients: Prevalence, predictors and clinical outcome. Thromb Res 2021; 198: 34-9.
[http://dx.doi.org/10.1016/j.thromres.2020.11.017] [PMID: 33271421]
[38]
Alharthy A, Aletreby W, Faqihi F, et al. Clinical characteristics and predictors of 28-day mortality in 352 critically Ill patients with COVID-19: A retrospective study. J Epidemiol Glob Health 2021; 11(1): 98-104.
[http://dx.doi.org/10.2991/jegh.k.200928.001] [PMID: 33095982]
[39]
Mir T, Attique HB, Sattar Y, et al. Does pulmonary embolism in critically ill COVID-19 patients worsen the in-hospital mortality: A metaanalysis. Cardiovasc Revasc Med 2020; S1553-8389(20): 30780-6.
[http://dx.doi.org/10.1016/j.carrev.2020.11.024]
[40]
Hunt B, Retter A, McClintock C. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. London, England: British Society for Haematology 2020.
[41]
Spyropoulos AC, Levy JH, Ageno W, et al. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020; 18(8): 1859-65.
[http://dx.doi.org/10.1111/jth.14929] [PMID: 32459046]
[42]
Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol 2020; 75(23): 2950-73.
[http://dx.doi.org/10.1016/j.jacc.2020.04.031] [PMID: 32311448]
[43]
Lanini S, Montaldo C, Nicastri E, et al. COVID-19 disease-Temporal analyses of complete blood count parameters over course of illness, and relationship to patient demographics and management outcomes in survivors and non-survivors: A longitudinal descriptive cohort study. PLoS One 2020; 15(12)e0244129
[http://dx.doi.org/10.1371/journal.pone.0244129] [PMID: 33370366]
[44]
Zhao Y, Nie HX, Hu K, et al. Abnormal immunity of non-survivors with COVID-19: Predictors for mortality. Infect Dis Poverty 2020; 9(1): 108.
[http://dx.doi.org/10.1186/s40249-020-00723-1] [PMID: 32746940]
[45]
Loo J, Spittle DA, Newnham M. COVID-19, immunothrombosis and venous thromboembolism: biological mechanisms. Thorax 2021; 76(4): 412-20.
[http://dx.doi.org/10.1136/thoraxjnl-2020-216243] [PMID: 33408195]
[46]
Tavakolpour S, Rakhshandehroo T, Wei EX, Rashidian M. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunol Lett 2020; 225: 31-2.
[http://dx.doi.org/10.1016/j.imlet.2020.06.013] [PMID: 32569607]
[47]
Türk S, Türk C, Malkan ÜY, et al. Current community transmission and future perspectives on the COVID-19 process. Turk J Med Sci 2021; 51(3): 1001-11.
[http://dx.doi.org/10.3906/sag-2012-310]
[48]
Liu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med 2020; 38(10): 2074-80.
[http://dx.doi.org/10.1016/j.ajem.2020.07.019] [PMID: 33142178]
[49]
Raschke RA, Agarwal S, Rangan P, Heise CW, Curry SC. Discriminant accuracy of the SOFA score for determining the probable mortality of patients with COVID-19 pneumonia requiring mechanical ventilation. JAMA 2021; 325(14): 1469-70.
[http://dx.doi.org/10.1001/jama.2021.1545] [PMID: 33595630]

Rights & Permissions Print Cite
Article Metrics
40
1
Wayfinder Image
Open Access Journals Promotions
World Prematurity Day
© 2024 Bentham Science Publishers | Privacy Policy