Clinical question: Can a proposed new scoring system triage and assess risk in COVID-19 patients with coagulopathy?
Dr. Ajala
Background: COVID-19-induced coagulopathy (CIC), marked elevation of D-dimer, cytokine storm, and in some instances, endothelial injury, are prominent features of COVID-19 infection. As a result, there is an increased risk of micro- and macrovascular thrombosis, as well as an increased incidence of anticoagulation failure in moderate to severe COVID-19 infection. Consequently, appropriate anticoagulation may help improve the chance of survival in COVID-19 patients. A scoring system to assess COVID-19-induced coagulopathy and to stratify patients for anticoagulation therapy based on risk categories might improve outcomes.
Study Design: Scoping review.
Setting: Scoping review of multiple retrospective cohort studies of COVID-19 patients who had inflammatory markers, organ failure, and macrovascular thrombosis noted on serial exam, weekly imaging, or postmortem.
Synopsis: This scoping review gives a brief overview of various coagulation parameters and how they function during COVID-19 infection. The CIC scoring system includes the sequential organ failure assessment (SOFA), sepsis-induced coagulopathy (SIC), and D-dimer value. This scoring system is different than SOFA and SIC because it not only combines them but also weighs the entities differently. D-dimer is weighed heavily because it correlates with mortality and response to anticoagulation. Although the CIC scoring system will need revision, it is promising because it may help triage patients’ risk categories for anticoagulation. The proposed CIC scoring system will benefit from prospective validation. Lastly, there should be further research on the impact of antiplatelet therapy on survival in COVID-19.
Bottom line: Randomized clinical trials are needed to identify the benefits of anticoagulation as well as to specify the most effective agent and appropriate dosing. Moreover, the CIC scoring system will require revision, prospective validation, and further revision as new data become available. Lastly, preliminary studies suggest a promising role for antiplatelet therapy in the management of COVID-19.
Citation: Hadid T et al. Coagulation and anticoagulation in COVID-19. Blood Rev. 2021 May;47:100761. doi: 10.1016/j.blre.2020.100761. Epub 2020 Oct 8. PMID: 33067035; PMCID: PMC7543932.
Dr. Ajala is a hospitalist and co-director of the division of hospital medicine’s education council at Emory University School of Medicine, Atlanta.