Two cases of acute liver failure complicated by COVID-19 remarkably responded to anticoagulant therapy

Abstract

Case 1 was an 83-year-old man. After testing positive for SARS-CoV-2 at a previous hospital, he was transferred to our hospital due to a rapid increase in liver enzymes. Although he had acute liver failure with coagulation abnormalities, when subcutaneous injection of unfractionated heparin was initiated, liver failure and coagulation abnormalities promptly improved. Case 2 was a 29-year-old man. After testing positive for SARS-CoV-2 in a previous hospital, a rapid increase in liver enzymes with coagulation abnormalities was observed. On day 6 of illness, he fell into a coma and was transferred to our hospital with a diagnosis of acute liver and renal failure. The initiation of artificial liver support therapy with unfractionated heparin improved his level of consciousness and liver failure. We report two rare cases in which coagulopathy and liver failure due to COVID-19 infection rapidly improved with intensive medical care, including early anticoagulant therapy.