COVID-19 assosiated coagulopathy and clinical features: A single-center report

Objective: Covid-19 is a quaint entitiy with hyper-inflammation, endothelial dysfunction and coagulopathy that may occur in its course. We present our experience regarding coagulopathy predictive factors in hospitalized Covid-19 patients just after pandemic declaration. Patients and Methods: A total of 511 hospitalized patients between March and May 2020 were retrospectively screened. 49 of them were excluded due to accompanying conditions resulting in high D-dimer levels. The treatment protocol includes hydroxychloroquine, azithromycin, favipiravir, low-molecular-weight heparin, dipyridamole and anti-cytokine agents on the hyper-inflammation phase. We stratified 3 groups, respectively proven coagulopathy (defines patients with macrovascular thrombosis and DIC), highly suspected coagulopathy (which represent possible dissemine pulmoner microthrombosis) and patients without coagulopathy. Highly suspected coagulopathy encompasses clinical deterioration with sudden D-dimer elevation. Results: The median age of the remaining patients was 56 years with a male/female ratio of 284/178. Proven coagulopathy developed in 3.2% and highly suspected coagulopathy in 10.1% of patients. In the multivariate analysis; not receiving LMWH (p = 0.002, hazard ratio: 5376.383), peak D-dimer level above 15000 U/ml (p = 0.013, hazard ratio: 1360.964), peak SIC score ≥ 4 (p = 0.022, risk ratio: 1270.538) was found to be significant for the development of coagulopathy and initial LDH level > 480 IU / L (p = 0.022, hazard ratio: 91.948), initial ferritin level > 1000 ng / ml(p = 0.036, risk factor: 0.010) for the development of highly suspected coagulopathy. In multivariate analysis with parameters of p < 0.1 in univariate analysis, not receiving LMWH (p = 0.001, risk factor: 34.565) was also significant for the development of highly suspected coagulopathy. In addition all DIC cases had gram-negative bacterial sepsis. Conclusion: According to our study, not receiving LMWH, D-dimer > 15000 U/ml, SIC score ≥ 4, LDH > 480 IU/L, initial ferritin > 1000 ng/ml are independent risk factors for COVID-19 assosiated coagulopathy and DIC does not appear to develop on the basis of COVID-19.