Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

M. Hardy, T. Lecompte, J. Douxfils, S. Lessire, J. M. Dogne, B. Chatelain, S. Testa, I. Gouin-Thibault, Y. Gruel, R. L. Medcalf, H. ten Cate, G. Lippi, F. Mullier*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

37 Citations (Web of Science)

Abstract

Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.

Original languageEnglish
Article number17
Number of pages16
JournalThrombosis Journal
Volume18
Issue number1
DOIs
Publication statusPublished - 7 Sep 2020

Keywords

  • Anticoagulation
  • CLINICAL CHARACTERISTICS
  • COVID-19
  • Coagulopathy
  • D-DIMER
  • D-dimers
  • Fibrinolysis
  • HEPARIN-INDUCED THROMBOCYTOPENIA
  • Hemostasis
  • Heparin
  • LOW FIBRINOGEN LEVELS
  • MONITORING UNFRACTIONATED HEPARIN
  • PARTIAL THROMBOPLASTIN TIME
  • PLASMINOGEN-ACTIVATOR INHIBITOR-1
  • PNEUMATIC TUBE SYSTEM
  • SOLUBLE FIBRIN
  • Thrombin generation
  • Thrombosis
  • VENOUS THROMBOEMBOLISM
  • Viscoelastic tests
  • CITRATE STORAGE

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