Highlights Use of a combination of vitamin D, magnesium, and vitamin B 12 (DMB) in patients with coronavirus disease (COVID-19) was studied. Fewer patients ≥50 y of age with COVID-19 on DMB suffered clinical deterioration. Further studies are warranted to ascertain the full benefit of DMB in patients with COVID-19.

developed thrombosis, our patients' CWA parameters remained remarkably high despite the use of thromboprophylaxis during their ICU stay. It is possible that CWA and other thrombin generation assays might not be sensitive enough to detect the haemostatic changes caused by the standard prophylactic dose of low molecular weight heparin.All three patients recovered from COVID-19 infection.Thatour findings of markedly raised CWA parameters in critically ill infected cases are possibly consistent with hypercoagulability is not unexpected. Such patients exhibit hyperinflammation and cytokine overdrive, and extensive crosstalk is known to exist in the cytokines, the inflammatory system, and coagulation. 6 Critically ill COVID-19 patients have been shown to have increased proinflammatory cytokines including IL-2 and TNF-α, 4 and these factors could upregulate the coagulation system. 6 We speculate that this could partially account for the CWA changes observed.Although our findings are limited by the relatively few patients and data points and by the lack of other correlation studies with other coagulation assays, we believe there are still valuable points to take away. Many of the specialized and research haemostatic assays cannot be safely and easily performed on samples collected from COVID-19 patients in view of laboratory biosafety concerns. As COVID-19 infection is spreading relentlessly worldwide, there is an urgent need for rapid and readily accessible biomarkers that can aid clinical stratification and management. So, CWA represents a simple, automated and rapid test, which fulfills these biosafety criteria. Whenever an aPTT is performed, an aPTT waveform is generated automatically by commonly used optical analysers worldwide.In conclusion, the rise of CWA parameters precedes and coincides with ICU admission and warrant further study to confirm its utility in the routine management of COVID-19 patients.

The high occurrence of cancer-associated thrombosis is associated with elevated thrombin generation. Tumour cells increase the potential for thrombin generation both directly, through the expression and release of procoagulant factors, and indirectly, through signals that activate other cell types (including platelets, leukocytes and erythrocytes). Furthermore, cancer treatments can worsen these effects. Coagulation factors, including tissue factor, and inhibitors of coagulation are altered and extracellular vesicles (EVs), which can promote and support thrombin generation, are released by tumour and other cells. Some phosphatidylserine-expressing platelet subsets and platelet-derived EVs provide the surface required for the assembly of coagulation factors essential for thrombin generation in vivo. This review will explore the causes of increased thrombin production in cancer, and the availability and utility of tests and biomarkers. Increased thrombin production not only increases blood coagulation, but also promotes tumour growth and metastasis and as a consequence, thrombin and its contributors present opportunities for treatment of cancer-associated thrombosis and cancer itself.