Characteristics of coagulation/fibrinolysis abnormalities in severe novel coronavirus disease 2019 (COVID-19) patients —Case series—

Abstract

We report the characteristics of coagulation/fibrinolysis abnormalities in 6 severe coronavirus disease 2019 (COVID-19) patients. One of 6 patients had a platelet count of < 10 × 10⁴/mm³ during the 8-day observation period from ICU admission. Both prothrombin-international normalized ratio and activated partial thromboplastin time remained almost within the normal ranges throughout the 8 days. In contrast, fibrin degradation products and D-dimer levels remained above the upper limits of the normal ranges throughout the 8 days, and levels in 2/6 cases increased markedly from day 7. Therefore, we strongly suspected as if an “enhanced-fibrinolytic type” but not a “suppressed-fibrinolytic type” coagulation/fibrinolysis abnormality, despite COVID-19 being an infectious disease. Disseminated intravascular coagulation (DIC) developed in 4/6 cases, according to the Japanese Association for Acute Medicine criteria DIC diagnostic criteria, and these cases were treated with recombinant human soluble thrombomodulin (rhsTM) for 6–7 days. After the rhsTM treatment the DIC status improved in 3/4 cases.