D-Dimer Trends in Patients Hospitalized With Covid-19: Patterns and in-Hospital Prognostic Significance

Ronderos, Diana; Omar, Alaa Mabrouk Salem; Haider, Sayed Waqas; Rehmani, Arsalan; Arenas, Alvaro Garcia; Urlapu, Kinnera Sahithi; Nicu, Marin; Bella, Jonathan N.; Chilimuri, Sridhar

doi:10.1016/s0735-1097(21)04386-2

Cited by 2 publications

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“…We recently reported that the variation in D-dimer trends during the hospital course involves specific trends that resulted in distinct patterns of in-hospital mortality. Here, we report a multicenter case series from infection waves during different time points in which we show the universality of such D-dimer trends and their risk ( 5 ).…”

Section: Introductionmentioning

confidence: 91%

D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves

Botero¹,

Omar

Pengo

et al. 2023

Front. Med.

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IntroductionVariable D-dimer trends during hospitalization reportedly result in distinct in-hospital mortality. In this multinational case series from the first and second waves, we show the universality of such D-dimer trends.MethodsWe reviewed 405 patients with COVID-19 during the first wave admitted to three institutions in the United States, Italy, and Colombia, and 111 patients admitted to the U.S. site during the second wave and 55 patients during the third wave. D-dimer was serially followed during hospitalization.ResultsDuring the first wave, 66 (15%) patients had a persistently-low pattern, 33 (8%) had early-peaking, 70 (16%) had mid-peaking, 94 (22%) had fluctuating, 30 (7%) had late-peaking, and 112 (26%) had a persistently-high pattern. During the second and third waves, similar patterns were observed. D-dimer patterns were significantly different in terms of in-hospital mortality similarly in all waves. Patterns were then classified into low-risk patterns (persistently-low and early-peaking), where no deaths were observed in both waves, high-risk patterns (mid-peaking and fluctuating), and malignant patterns (late-peaking and persistently-high). Overall, D-dimer trends were associated with an increased risk for in-hospital mortality in the first wave (overall: HR: 1.73) and stayed the same during the second (HR: 1.67, p < 0.001) and the third (HR: 4.4, p = 0.001) waves.ConclusionD-dimer behavior during COVID-19 hospitalization yielded universal categories with distinct mortality risks that persisted throughout all studied waves of infection. Monitoring D-dimer behavior may be useful in the management of these patients.

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Section: Introductionmentioning

confidence: 91%

D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves

Botero¹,

Omar

Pengo

et al. 2023

Front. Med.

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Anticoagulation for hypercoagulability in severe critical COVID-19: A case series of fading and fatal cycles of microthrombosis

Botero

Omar

Nicu

et al. 2021

Journal of Cardiology Cases

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The pathophysiology of the COVID-19 involves a systemic hypercoagulable state and systemic micro-thrombosis which can cause fatal consequences. Despite that anticoagulation seems an intuitive therapeutic option, the US National Institute of Health has issued a warning against its use in critically ill patients. We present five cases of imaging-proven or clinically suspected hypercoagulability with hemodynamic compromise despite therapeutic anticoagulation. We describe the patients with thoughts on links between pathophysiology and the laboratory values, clinical course, and imaging studies in each case. All patients presented to the hospital with symptoms and chest imaging suggestive of COVID-19 pneumonia. All patients presented with severe hypoxia requiring mechanical ventilation, and received full anticoagulation for treatment of hypercoagulable state suggested by elevated D-dimer. All but one patient received alteplase for thrombolytic therapy of suspected massive pulmonary embolism (PE). On the basis of this case series, hypercoagulability in COVID-19 is a late manifestation of the disease that persists despite anticoagulation, is cyclic in nature based on D-dimer despite thrombolysis, and is fatal if it rebounds. The use of anticoagulation and thrombolysis in these patients seemed harmful or non-beneficial. Early intervention before D-dimer elevation and hemodynamic compromise may benefit in preventing thromboembolic burden.

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D-Dimer Trends in Patients Hospitalized With Covid-19: Patterns and in-Hospital Prognostic Significance

Cited by 2 publications

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D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves

D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves

Anticoagulation for hypercoagulability in severe critical COVID-19: A case series of fading and fatal cycles of microthrombosis

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