COVID‐19 Coagulopathy in Caucasian patients
ISTH Academy. 05/21/20; 9442
Label: External COVID-19 Resources
Description
Abstract
Although the pathophysiology underlying severe COVID‐19 remains poorly understood, accumulating data suggest that a lung‐centric coagulopathy may play an important role. Elevated D‐dimer levels which correlated inversely with overall survival were recently reported in Chinese cohort studies. Critically however, ethnicity has major effects on thrombotic risk, with a 3‐4 fold lower risk in Chinese compared to Caucasians and a significantly higher risk in African‐Americans. In this study, we investigated COVID‐19 coagulopathy in Caucasian patients. Our findings confirm that severe COVID‐19 infection is associated with a significant coagulopathy that correlates with disease severity. Importantly however, Caucasian COVID‐19 patients on LMWH thrombo‐prophylaxis rarely develop overt DIC. In rare COVID‐19 cases where DIC does develop, it tends to be restricted to late stage disease. Collectively, these data suggest that the diffuse bilateral pulmonary inflammation observed in COVID‐19 is associated with a novel pulmonary‐specific vasculopathy which we have termed pulmonary intravascular coagulopathy (PIC) as distinct to DIC. Given that thrombotic risk is significantly impacted by race, coupled with the accumulating evidence that coagulopathy is important in COVID‐19 pathogenesis, our findings raise the intriguing possibility that pulmonary vasculopathy may contribute to the unexplained differences that are beginning to emerge highlighting racial susceptibility to COVID‐19 mortality.
Disclaimer
Answers to questions about COVID-19 published herein are provided by the International Society on Thrombosis and Haemostasis, Inc. (“ISTH”) for voluntary, informational use by providers in the rapidly evolving novel coronavirus crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ISTH provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information, including but not limited to its completeness or accuracy. ISTH specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ISTH assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ISTH website Terms of Use.
The appearance of external hyperlinks does not constitute endorsement by ISTH of the linked websites, or the information, products or services contained therein. ISTH does not exercise any editorial control over the information you may find at these locations nor does ISTH make any representation of their accuracy or completeness. Please contact those websites with any questions
Although the pathophysiology underlying severe COVID‐19 remains poorly understood, accumulating data suggest that a lung‐centric coagulopathy may play an important role. Elevated D‐dimer levels which correlated inversely with overall survival were recently reported in Chinese cohort studies. Critically however, ethnicity has major effects on thrombotic risk, with a 3‐4 fold lower risk in Chinese compared to Caucasians and a significantly higher risk in African‐Americans. In this study, we investigated COVID‐19 coagulopathy in Caucasian patients. Our findings confirm that severe COVID‐19 infection is associated with a significant coagulopathy that correlates with disease severity. Importantly however, Caucasian COVID‐19 patients on LMWH thrombo‐prophylaxis rarely develop overt DIC. In rare COVID‐19 cases where DIC does develop, it tends to be restricted to late stage disease. Collectively, these data suggest that the diffuse bilateral pulmonary inflammation observed in COVID‐19 is associated with a novel pulmonary‐specific vasculopathy which we have termed pulmonary intravascular coagulopathy (PIC) as distinct to DIC. Given that thrombotic risk is significantly impacted by race, coupled with the accumulating evidence that coagulopathy is important in COVID‐19 pathogenesis, our findings raise the intriguing possibility that pulmonary vasculopathy may contribute to the unexplained differences that are beginning to emerge highlighting racial susceptibility to COVID‐19 mortality.
Disclaimer
Answers to questions about COVID-19 published herein are provided by the International Society on Thrombosis and Haemostasis, Inc. (“ISTH”) for voluntary, informational use by providers in the rapidly evolving novel coronavirus crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ISTH provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information, including but not limited to its completeness or accuracy. ISTH specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ISTH assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ISTH website Terms of Use.
The appearance of external hyperlinks does not constitute endorsement by ISTH of the linked websites, or the information, products or services contained therein. ISTH does not exercise any editorial control over the information you may find at these locations nor does ISTH make any representation of their accuracy or completeness. Please contact those websites with any questions
Abstract
Although the pathophysiology underlying severe COVID‐19 remains poorly understood, accumulating data suggest that a lung‐centric coagulopathy may play an important role. Elevated D‐dimer levels which correlated inversely with overall survival were recently reported in Chinese cohort studies. Critically however, ethnicity has major effects on thrombotic risk, with a 3‐4 fold lower risk in Chinese compared to Caucasians and a significantly higher risk in African‐Americans. In this study, we investigated COVID‐19 coagulopathy in Caucasian patients. Our findings confirm that severe COVID‐19 infection is associated with a significant coagulopathy that correlates with disease severity. Importantly however, Caucasian COVID‐19 patients on LMWH thrombo‐prophylaxis rarely develop overt DIC. In rare COVID‐19 cases where DIC does develop, it tends to be restricted to late stage disease. Collectively, these data suggest that the diffuse bilateral pulmonary inflammation observed in COVID‐19 is associated with a novel pulmonary‐specific vasculopathy which we have termed pulmonary intravascular coagulopathy (PIC) as distinct to DIC. Given that thrombotic risk is significantly impacted by race, coupled with the accumulating evidence that coagulopathy is important in COVID‐19 pathogenesis, our findings raise the intriguing possibility that pulmonary vasculopathy may contribute to the unexplained differences that are beginning to emerge highlighting racial susceptibility to COVID‐19 mortality.
Disclaimer
Answers to questions about COVID-19 published herein are provided by the International Society on Thrombosis and Haemostasis, Inc. (“ISTH”) for voluntary, informational use by providers in the rapidly evolving novel coronavirus crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ISTH provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information, including but not limited to its completeness or accuracy. ISTH specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ISTH assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ISTH website Terms of Use.
The appearance of external hyperlinks does not constitute endorsement by ISTH of the linked websites, or the information, products or services contained therein. ISTH does not exercise any editorial control over the information you may find at these locations nor does ISTH make any representation of their accuracy or completeness. Please contact those websites with any questions
Although the pathophysiology underlying severe COVID‐19 remains poorly understood, accumulating data suggest that a lung‐centric coagulopathy may play an important role. Elevated D‐dimer levels which correlated inversely with overall survival were recently reported in Chinese cohort studies. Critically however, ethnicity has major effects on thrombotic risk, with a 3‐4 fold lower risk in Chinese compared to Caucasians and a significantly higher risk in African‐Americans. In this study, we investigated COVID‐19 coagulopathy in Caucasian patients. Our findings confirm that severe COVID‐19 infection is associated with a significant coagulopathy that correlates with disease severity. Importantly however, Caucasian COVID‐19 patients on LMWH thrombo‐prophylaxis rarely develop overt DIC. In rare COVID‐19 cases where DIC does develop, it tends to be restricted to late stage disease. Collectively, these data suggest that the diffuse bilateral pulmonary inflammation observed in COVID‐19 is associated with a novel pulmonary‐specific vasculopathy which we have termed pulmonary intravascular coagulopathy (PIC) as distinct to DIC. Given that thrombotic risk is significantly impacted by race, coupled with the accumulating evidence that coagulopathy is important in COVID‐19 pathogenesis, our findings raise the intriguing possibility that pulmonary vasculopathy may contribute to the unexplained differences that are beginning to emerge highlighting racial susceptibility to COVID‐19 mortality.
Disclaimer
Answers to questions about COVID-19 published herein are provided by the International Society on Thrombosis and Haemostasis, Inc. (“ISTH”) for voluntary, informational use by providers in the rapidly evolving novel coronavirus crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ISTH provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information, including but not limited to its completeness or accuracy. ISTH specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ISTH assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ISTH website Terms of Use.
The appearance of external hyperlinks does not constitute endorsement by ISTH of the linked websites, or the information, products or services contained therein. ISTH does not exercise any editorial control over the information you may find at these locations nor does ISTH make any representation of their accuracy or completeness. Please contact those websites with any questions
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