• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
COVID-19 Clinical Features

COVID-19 and Coagulopathy

image_pdfFavoriteLoadingFavorite

PURPOSE:

  • Zhang et al. report on their findings of significant coagulopathy and antiphospholipid antibodies in patients with COVID-19

METHODS:

  • Case Series
    • ICU set up on an emergency basis for critically ill COVID-19 in Wuhan, China
  • Participants
    • 3 cases with coagulopathy, antiphospholipid antibodies and multiple infarcts

RESULTS:

Case 1

  • 69-year-old male
    • Comorbidities: Hypertension | Diabetes |History of stroke
    • Confirmed SARS-CoV-2 based on RT-PCR testing
  • Presentation
    • Fever | Cough | Dyspnea | Diarrhea | Headache
  • Clinical course
    • Required mechanical ventilation
    • Ischemia in the lower limbs bilaterally and left-hand digits
    • Neuro CT: Bilateral cerebral infarcts
    • Labs: Leukocytosis| Thrombocytopenia | Elevated PT, aPTT, fibrinogen and d-dimer | Anticardiolipin IgA antibodies, anti–β2-glycoprotein I IgA and IgG antibodies

Case 2

  • 65-year-old female
    • Comorbidities: Hypertension | Diabetes | CAD
    • No history of thrombosis
  • Presentation
    • Fever | Cough | Dyspnea
  • Clinical course
    • Required mechanical ventilation
    • Neuro CT: Bilateral cerebral infarcts
    • Labs: Leukocytosis| Thrombocytopenia | Elevated PT, aPTT, fibrinogen and d-dimer | Anticardiolipin IgA antibodies, anti–β2-glycoprotein I IgA and IgG antibodies

Case 3

  • 70-year-old male
    • Comorbidities: Hypertension | Nasopharyngeal carcinoma | Emphysema | Stroke
  • Presentation
    • Fever | Fatigue | Dyspnea | Headache
  • Clinical course
    • Required mechanical ventilation
    • Neuro CT: Bilateral cerebral infarcts
    • Labs: Leukocytosis| Thrombocytopenia | Elevated PT, aPTT, fibrinogen and d-dimer | Anticardiolipin IgA antibodies, anti–β2-glycoprotein I IgA and IgG antibodies

CONCLUSION:

  • Antiphospholipid antibodies can appear in critically ill patients with infections
  • Thrombotic events can arise in critically ill patients due to
    • Antiphospholipid antibodies
    • DIC
    • Heparin-induced thrombocytopenia
    • Thrombotic microangiopathy
  • ISTH has released guidance on the management of coagulopathy in the setting of COVID-19 that include the following key points (see ‘Learn More – Primary Sources’)
    • Along with other key coag labs, monitor fibrinogen | Nonsurvivors may develop DIC around day 4
    • Use prophylactic dose low-molecular-weight heparin unless there is active bleeding or a platelet count of <25×109/L
    • Keep platelet counts >50×109/L in patients with bleeding and >20×109/L in nonbleeding patients | Fibrinogen >2.0 g/L | Prothrombin ratio <1.5

Learn More – Primary Sources:

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

ISTH interim guidance on recognition and management of coagulopathy in COVID‐19

Get COVID-19 Research Summaries Direct to Your Phone, with ObGFirst

Try it Free »

image_pdfFavoriteLoadingFavorite
< Previous
All COVID-19 Clinical Features Posts
Next >

Related ObG Topics:

ARDS, Critical Care and COVID-19: ‘Surviving Sepsis Campaign’ Guidelines and Key Points
COVID-19 Guidance: Key Highlights for Healthcare Professionals
COVID-19 and Liver Impairment: How Often Are ALT and AST Elevated?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site