Diagnosis and management of sepsis‐induced coagulopathy and disseminated intravascular coagulation

Iba, Toshiaki; Levy, Jerrold H.; Warkentin, Theodore E.; Thachil, Jecko; Poll, Tom van der; Levi, Marcel; Scientific,

doi:10.1111/jth.14578

Cited by 379 publications

(333 citation statements)

References 44 publications

(85 reference statements)

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“…10 ISTH established a scoring system to identify "sepsis-induced coagulopathy" (SIC), with a SIC score > 4 indicative of early phase disseminated intravascular coagulation (DIC). 10 Lymphocytes have a critical role in the immune response to viral infections, with lymphopenia correlating with illness severity and hospitalization in COVID-19. 14 In a series from Wuhan, China, including 52 critically ill patients, lymphopenia occurred in 80%.…”

Section: Discussionmentioning

confidence: 99%

“…While Huang et al did not observe significant APTT elevations with COVID-19 outside pregnancy,7 Tang et al noted increased mortality with high APTT, prothrombin time, D-dimer, and fibrin degradation products compared to COVID-19 survivors 8. Neither APTT nor low fibrinogen was assessed in a pregnancy series,11 although both are part of DIC classification 10. Two guidelines addressing coagulopathy in COVID-19 9,12 highlight D-dimer elevation, thrombocytopenia, and low fibrinogen as poor prognostic indicators of mortality risk.…”

mentioning

confidence: 99%

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COVID‐19 and acute coagulopathy in pregnancy

Koumoutsea

Vivanti

Shehata

et al. 2020

Journal of Thrombosis and Haemostasis

151

128

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The present COVID-19 pandemic due to SARS-CoV-2 novel coronavirus has resulted in high numbers of critically ill patients and deaths. 1 Emerging data on the maternal impact of COVID-19 suggest that the clinical course is similar irrespective of pregnancy. [2][3][4] However, despite these data, our report of two pregnancies with COVID-19-related, rapidly progressive coagulopathy may warrant caution.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

COVID‐19 and acute coagulopathy in pregnancy

Koumoutsea

Vivanti

Shehata

et al. 2020

Journal of Thrombosis and Haemostasis

151

128

View full text Add to dashboard Cite

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“…Specifically, among 191 COVID-19 patients seen at two hospitals in Wuhan, D-dimer levels over 1 µg/L at admission predicted an 18-fold increase in odds of dying before discharge [14]. Of note, when DIC is caused by a systemic infection, it features an acute systemic over-inflammatory response, strictly linked to endothelial dysfunction [169].…”

Section: Thromboembolism and Covid-19mentioning

confidence: 99%

“…Consequently, these phenomena could result in pulmonary embolism with occlusion and micro-thrombosis in pulmonary small vessels, as observed in critical COVID-19 patients [248]. Apart from cases of pulmonary embolism, COVID-19 can cause a sepsis-associated DIC, which is defined as "sepsis-induced coagulopathy" (SIC) [169]. Thus, there is an increasing interest in anticoagulant therapy to treat COVID-19 [249].…”

Section: Anticoagulation As a Key Therapy For Covid-19mentioning

confidence: 99%

Hypertension, Thrombosis, Kidney Failure, and Diabetes: Is COVID-19 an Endothelial Disease? A Comprehensive Evaluation of Clinical and Basic Evidence

Sardu

Gambardella

Morelli

et al. 2020

JCM

463

436

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The symptoms most commonly reported by patients affected by coronavirus disease (COVID-19) include cough, fever, and shortness of breath. However, other major events usually observed in COVID-19 patients (e.g., high blood pressure, arterial and venous thromboembolism, kidney disease, neurologic disorders, and diabetes mellitus) indicate that the virus is targeting the endothelium, one of the largest organs in the human body. Herein, we report a systematic and comprehensive evaluation of both clinical and preclinical evidence supporting the hypothesis that the endothelium is a key target organ in COVID-19, providing a mechanistic rationale behind its systemic manifestations.

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“…One of the emerging hallmarks of severe COVID-19 is a coagulopathy that has been termed "sepsis-induced coagulopathy" (SIC) with high D-dimer levels and elevated fibrinogen [3,4]. SIC is a precursor state to DIC and associated with elevated prothrombin time (PT), elevated D-dimer, and thrombocytopenia, but without hypofibrinogenemia.…”

Section: Coagulopathymentioning

confidence: 99%

COVID-19-Related Stroke

Hess

Eldahshan

Rutkowski

2020

Transl. Stroke Res.

352

330

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The COVID-19 pandemic is associated with neurological symptoms and complications including stroke. There is hypercoagulability associated with COVID-19 that is likely a "sepsis-induced coagulopathy" and may predispose to stroke. The SARS-CoV-2 virus binds to angiotensin-converting enzyme 2 (ACE2) present on brain endothelial and smooth muscle cells. ACE2 is a key part of the renin angiotensin system (RAS) and a counterbalance to angiotensin-converting enzyme 1 (ACE1) and angiotensin II. Angiotensin II is proinflammatory, is vasoconstrictive, and promotes organ damage. Depletion of ACE2 by SARS-CoV-2 may tip the balance in favor of the "harmful" ACE1/angiotensin II axis and promote tissue injury including stroke. There is a rationale to continue to treat with tissue plasminogen activator for COVID-19-related stroke and low molecular weight heparinoids may reduce thrombosis and mortality in sepsis-induced coagulopathy.

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Diagnosis and management of sepsis‐induced coagulopathy and disseminated intravascular coagulation

Cited by 379 publications

References 44 publications

COVID‐19 and acute coagulopathy in pregnancy

COVID‐19 and acute coagulopathy in pregnancy

Hypertension, Thrombosis, Kidney Failure, and Diabetes: Is COVID-19 an Endothelial Disease? A Comprehensive Evaluation of Clinical and Basic Evidence

COVID-19-Related Stroke

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