Table 1.
Coagulation and fibrinolysis tests to be performed in COVID-19
| Markers | Significance of test |
|---|---|
| Platelets | Decreased due to various causes (see text) |
| PT | Screening test for vitamin K deficiency (diagnosis confirmed by PIVKA-II) |
| Evaluation of liver failure | |
| APTT | UFH monitoring |
| LA screening test | |
| Screening test for acquired hemophilia | |
| Fibrinogen | Diagnosis of DIC (particularly enhanced-fibrinolytic-type DIC). Beware of short-term dips within a few days |
| If fibrinogen rises, the patient is in a hypercoagulable state | |
| Evaluation of liver failure | |
| FDP/d-dimer | Diagnosis of DIC (particularly enhanced-fibrinolytic-type DIC). Watch out for short-term spikes within a few days. In enhanced-fibrinolytic-type DIC, FDP increases markedly, but d-dimer increases only mildly to moderately, so a divergence phenomenon is observed between FDP and d-dimer levels |
| Diagnosis of macro- or microthrombosis | |
| Reflecting lung damage | |
| Antithrombin | Evaluation of liver failure |
| If the activity is decreased in patients with DIC, consider administration of a concentrated antithrombin preparation | |
| TAT | Evaluation of coagulation activation |
| PIC | Evaluation of fibrinolytic activation |
| α2 PI | If α2 PI activity is significantly decreased in a case where PIC is significantly increased, major bleeding is likely to occur |
| VWF antigen and activity | Screening test for acquired von Willebrand syndrome. In acquired von Willebrand disease, VWF activity is reduced compared to the amount of VWF antigen |
PT prothrombin time, APTT activated partial thromboplastin time, FDP fibrin/fibrinogen degradation products, TAT thrombin-antithrombin complex, PIC plasmin-α2 plasmin inhibitor complex, α2 PI α2 plasmin inhibitor, VWF von Willebrand factor, UFH unfractionated heparin, LA lupus anticoagulant, DIC disseminated intravascular coagulation