Update to coagulopathy in COVID-19: Manifestations and management

Simon R Mucha; Siddharth Dugar; Keith McCrae; Douglas Joseph; John Bartholomew; Gretchen L Sacha; Michael Militello

doi:10.3949/ccjm.87a.ccc024-up

Update to coagulopathy in COVID-19: Manifestations and management

Cleve Clin J Med. 2021 Jun 2. doi: 10.3949/ccjm.87a.ccc024-up. Online ahead of print.

Authors

Simon R Mucha¹, Siddharth Dugar², Keith McCrae³, Douglas Joseph⁴, John Bartholomew⁵, Gretchen L Sacha⁶, Michael Militello⁶

Affiliations

¹ Critical Care Medicine, Respiratory Institute, Cleveland Clinic; Clinical Instructor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
² Pulmonary Medicine, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
³ Hematology and Medical Oncology, and Cellular and Molecular Medicine, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
⁴ Cardiovascular Medicine, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
⁵ Cardiovascular Medicine, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH barthoj@ccf.org.
⁶ Inpatient Pharmacy, Cleveland Clinic.

PMID: 33323363
DOI: 10.3949/ccjm.87a.ccc024-up

Abstract

Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality. Markedly elevated levels of D-dimer with normal fibrinogen levels are the hallmark laboratory findings of severe COVID-19-associated coagulopathy. Prophylaxis against venous thromboembolism is paramount for all hospitalized patients with COVID-19, with more aggressive prophylaxis and screening recommended for critically ill patients with D-dimer levels above 3.0 μg/mL. Point-of-care ultrasonography is the imaging method of choice for patients at high risk, as it entails minimal risk of exposing providers to the virus.