Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2

Abstract

Severe coronavirus disease 2019 is commonly complicated with coagulopathy, the difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2 has not been analyzed. Coagulation results and clinical features of consecutive patients with severe pneumonia induced by SARS-CoV2 (COVID group) and non-SARS-CoV2 (non-COVID group) in Tongji hospital were retrospectively analyzed and compared. Whether patients with elevated D-dimer could benefit from anticoagulant treatment was evaluated. There were 449 COVID patients and 104 non-COVID patients enrolled into the study. The 28-day mortality in COVID group was approximately twofold of mortality in non-COVID group (29.8% vs. 15.4%, P = 0.003), COVID group were older (65.1 ± 12.0 vs. 58.4 ± 18.0, years, P < 0.001) and with higher platelet count (215 ± 100 vs. 188 ± 98, ×10 9 /L, P = 0.015), comparing to non-COVID group. The 28-day mortality of heparin users were lower than nonusers In COVID group with D-dimer > 3.0 μg/mL (32.8% vs. 52.4%, P = 0.017). Patients with severe pneumonia induced by SARS-CoV2 had higher platelet count than those induced by non-SARS-CoV2, and only the former with markedly elevated D-dimer may benefit from anticoagulant treatment.

Recomendaciones sobre el tratamiento antitrombótico durante la pandemia COVID-19. Posicionamiento del Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología

“…Dichos pacientes en situación crítica presentan un aumento del riesgo tromboembólico, por lo que las estrategias de prevención efectiva de la ETEV son cruciales 17 . Estudios realizados en la población de Wuhan mostraron una alta incidencia de ETEV (de hasta el 20% de los pacientes ingresados en las unidades de cuidados intensivos) asociada con una elevada mortalidad 18,19 . Sin embargo, las estrategias óptimas de anticoagulación profiláctica y terapéutica durante el ingreso hospitalario no están claramente establecidas 20 .…”

“…Los pacientes con indicación de anticoagulación previa a la infección por SARS-CoV-2 suelen tener fibrilación auricular o ETEV y ser portadores de una prótesis valvular mecánica. En la figura 2 se presenta un algoritmo de abordaje de los pacientes con anticoagulación oral previa ingresados por infección por COVID-19, en el que se propone el cambio a anticoagulación parenteral (fundamentalmente por la situación de gravedad o por interacciones medicamentosas con fármacos para tratar la COVID- 19). No hay evidencia clara sobre el mantenimiento de la anticoagulación oral de los pacientes que ingresan por infección por SARS-CoV-2, aunque a priori se podría mantener en los pacientes estables y que no toman ningún fármaco potencialmente causante de una interacción.…”

“…La pandemia producida por la infección del nuevo coronavirus SARS-CoV-2, que da lugar a una enfermedad altamente contagiosa (COVID- 19), ha producido un colapso de los sistemas sanitarios de todo el mundo. Se ha descrito que estos pacientes sufren un estado inflamatorio que condiciona un alto riesgo trombótico.…”

COVID-19 — Toward a comprehensive understanding of the disease

“…Endothelial dysfunction might be caused by direct infection and an inflammatory response, finally leading to microvascular dysfunction, organ ischemia, inflammation and subsequently to apoptosis [116,117]. In summary, endothelial dysfunction, cytokine storm, oxidative stress, as well as upregulation of angiotensin-II may essentially explain the coagulopathy seen in severe COVID-19 patients [118]. Last but not least, since hypercoagulability and systemic inflammatory activity can persist, COVID-19 infection may influence long-term outcomes [119].…”

Protein structure analysis of the interactions between SARS-CoV-2 spike protein and the human ACE2 receptor: from conformational changes to novel neutralizing antibodies

“…At the same time viral protease inhibitors (7)(8)(9)(10) are under investigation for their ability in preventing virus protein (with specific reference to spike proteins) cleavage (11) leading to the fusion of virus proteins with host cell membranes. Also anti-inflammatory antibodies/drugs in combination with anticoagulant molecules are under investigation for limiting coagulopathies (12)(13)(14)(15) and cytokine signaling impressively triggered by SARS-CoV-2 infection (16)(17)(18)(19)(20). Finally, the same SARS-CoV-2 spike protein has become the most investigated target due to its ability in forming interactions with the human ACE2 receptor, causing fusion events that make possible for the virus to penetrate host human cells (21)(22)(23).…”