While there is an associated coagulopathy with COVID-19, bleeding manifestations, even in those with disseminated intravascular coagulopathy (DIC), have not been reported.
In their study report published last week, Connors and Levy acknowledged that the SARS-CoV-2 coronavirus induced infection can be associated with a coagulopathy – findings consistent with infection induced inflammatory changes as observed in patients with DIC.
The lungs, they note in their study abstract, are the target organ for COVID-19; patients develop acute lung injury which can progress to respiratory failure, although multi-organ failure can also occur.
The initial coagulopathy of COVID-19 presents with prominent elevation of D-dimer and fibrin/fibrinogen degradation products, while abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon in initial presentations. “Coagulation test screening, including the measurement of D-dimer and fibrinogen levels, is suggested,” they continue.
“COVID-19 associated coagulopathy should be managed as it would be for any critically ill patient, following the established practice of using thromboembolic prophylaxis for critically ill hospitalized patients, and standard supportive care measures for those with sepsis-induced coagulopathy or DIC.”
Although D-dimer, sepsis physiology, and consumptive coagulopathy are indicators of mortality, current data do not suggest the use of full intensity anticoagulation doses unless otherwise clinically indicated.
“Even though there is an associated coagulopathy with COVID-19, bleeding manifestations, even in those with DIC,” the authors conclude, “have not been reported. If bleeding does occur, standard guidelines for the management of DIC and bleeding should be followed.”
REFERENCE: Connors and Levy: COVID-19 and its implications for thrombosis and anticoagulation; https://ashpublications.org/blood/article/doi/10.1182/blood.2020006000/454646/COVID19-and-its-implications-for-thrombosis-and