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Case Reports
. 2020 Jul 31;99(31):e21513.
doi: 10.1097/MD.0000000000021513.

D-dimer surge and coagulation disorders in COVID-19 related pneumonia patients with cardiac injury: A case series

Xingtong Wang  1 , Beibei Du  2 , Jia Li  1 , Shunan Wang  1 , Xiuxiu Wang  1 , MengYuan Guo  1 , Bo Yang  3 , Daoyuan Si  2 , Ou Bai  1
Affiliations
Case Reports

D-dimer surge and coagulation disorders in COVID-19 related pneumonia patients with cardiac injury: A case series

Xingtong Wang et al. Medicine (Baltimore). .

Abstract

Background: Cardiac injury and coagulation disorders have been two increasing concerns in the management of patients with severe coronavirus disease (COVID-19). Coagulation disorders in COVID-19 patients with cardiac injury have not been characterized.

Methods: We analyzed the data of five COVID-19 patients with cardiac injury who had D-dimer surge (defined as a rapid increase in the D-dimer level in 72 h, from <5-21 μg/mL) during hospitalization, which were extracted from a registered retrospective study (ChiCTR2000031301). Clinical data and data on changes in coagulation parameters were collected, verified, and characterized.

Results: Among these five patients, four had pre-existing cardiovascular or cerebrovascular diseases. D-dimer surge was accompanied with prolonged prothrombin time (PT) and reduced platelet count (PLT) and fibrinogen level. Three patients had an ISTH DIC score of 5 and met the criteria for overt DIC. All five patients needed invasive ventilation support and were incubated 0 to 6 days after the first D-dimer upper reference limit (URL) was reached. All five patients died within 10 days after the first D-dimer URL was reached. All five patients had observed D-dimer URL results 1 to 3 days before death.

Conclusion: D-dimer surge in COVID-19 patients with cardiac injury surely leads to worse in-hospital outcome. D-dimer surge and concomitant DIC can be the leading causes of in-hospital death. Pre-existing cardiovascular or cerebrovascular diseases might pose a higher risk for developing these coagulation disorders. These findings can serve as hypothesis generating and need further clinical trials to confirm.

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Conflict of interest statement

The authors have no conflict of interests to disclose.

Figures

Figure 1
Figure 1
Representative pulmonary CT images of COVID-19-related pneumonia. Panels A–E represent pulmonary CT results of patients 1 to 5.
Figure 2
Figure 2
D-dimer surge and its relation with in-hospital death in COVID-19 patients with cardiac injury. Panel A: D-dimer surge in 5 patients. Time is calculated since the onset of illness. Please note that the changes in the curves of D-dimer levels in patients 1 and 2 are highly coincident. Panel B: D-dimer level, D-dimer surge, and in-hospital death. Time is calculated since death. Different D-dimer levels are marked with different colors.
Figure 3
Figure 3
Concomitant coagulation disorders during D-dimer surge. (A–D) Panel plot of concomitant PT, APTT, PLT count, and fibrinogen changes during and shortly after D-dimer surge. APTT = activated partial thromboplastin time, PLT = platelet, PT = prothrombin time.
See this image and copyright information in PMC

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References

    1. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020. - PMC - PubMed
    1. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020. - PMC - PubMed
    1. Si D, Du B, Ni L, et al. Death, discharge and arrhythmias among patients with COVID-19 and cardiac injury. Can Med Assoc J 2020;doi: 10.1503/cmaj.200879. - PMC - PubMed
    1. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844–7. - PMC - PubMed
    1. Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 2020;doi: 10.1111/jth.14975. - PMC - PubMed

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