Covid and coagulopathy

Coagulopathy Associated with COVID-19 Brady L. Stein, MD, MHS reviewing Thachil J et al. J Thromb Haemost 2020 Mar 25 An international panel provides guidance on prognostic variables and management strategies for COVID-19–associated coagulopathy. Lymphopenia is a common hematological abnormality among patients with COVID-19. In addition to respiratory failure, patients with severe illness are also likely to have coagulopathy. Practical guidance that can be applied in higher- and lower-resource healthcare settings is needed. As such, on behalf of the International Society on Thrombosis and Haemostasis, experts have created an interim guidance statement on the management of coagulopathy in COVID-19 patients. Key points include the following: Upon presentation of COVID-19, the measurements advised, in order of importance, are of d-dimer, prothrombin time, and platelet counts. Increased d-dimers are commonly reported in patients with severe illness and may predict mortality. Prolongation in prothrombin times and degree of thrombocytopenia (100–150×109/L) have been modest. In addition to the above parameters, fibrinogen should be monitored; nonsurvivors with severe illness have developed disseminated intravascular coagulation around day 4; significant worsening in these parameters at days 10 and 14 was also reported. The panel advises use of prophylactic dose low-molecular-weight heparin unless there is active bleeding or a platelet count of <25×109/L; it is hoped that this strategy will impact septic-like coagulopathy and protect against venous thromboembolism. Bleeding has been rare, but if present, panelists advise keeping platelet counts >50×109/L (and >20×109/L goal in nonbleeding patients), fibrinogen >2.0 g/L, and the prothrombin ratio <1.5

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Not only D-dimers & thrombocytopenia or prolonged prothrombin time Elevated Liver enzymes, CRP, LDH, BUN Decreased level of Procalcitonin
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Prolongation in prothombin time and thrombocytopenia, fibrinogen - these are to be monitored before DIC develops on day4
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Informative
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Agreed with Dr.Sanjoy S