Table I.
Demographics, clinical history, investigations and relevant coagulation studies of two patients with COVID‐19.
| Patient 1 | Patient 2 | |
|---|---|---|
| Demographics | ||
| Age, years | 61 | 73 |
| Sex | Male | Male |
| Baseline dependency | Independent | Independent |
| Body mass index, kg/m2 | 25·5 | 27·7 |
| Admission findings | ||
| Past medical history | Ischaemic heart disease, type 2 diabetes mellitus, hypertension, atrial flutter | Nil |
| Symptoms at disease onset | Cough, breathlessness, fevers, myalgia, headache | Breathlessness, altered taste and smell, fevers |
| Days from onset of first symptoms to hospital admission | 6 | 10 |
| Radiographic features on admission – chest X‐ray | Bilateral peripheral airspace opacification, right upper zone consolidation. | Bilateral patchy infiltrates with associated basal pleural effusion, left basal consolidation. |
| Treatment prior to ICU admission | CPAP trial, intravenous antibiotics | CPAP trial, intravenous antibiotics |
| COVID‐19 diagnosis | Positive RT‐PCR for SARS‐CoV‐2 | Negative RT‐PCR for SARS‐CoV‐2 but strong clinical suspicion and radiographic evidence |
| Admission to ICU | ||
| Days from onset of first symptoms to ICU admission | 11 | 15 |
| Disease severity (APACHE II) | Critical (8) | Critical (11) |
| P/F ratio | 145 | 142 |
| Laboratory findings on ICU admission | ||
| WCC (3·7–9·5), × 109/l | 18·7 | 11·7 |
| Neutrophil (1·7–6·1), × 109/l | 16·1 | 9·8 |
| Lymphocytes (1–3·2), × 109/l | 0·7 | 0·5 |
| Monocytes (0–0·8), × 109/l | 1·9 | 1·2 |
| Platelets (140–400), × 109/l | 410 | 159 |
| Haemoglobin (133–167), g/l | 132 | 113 |
| Albumin (25–35), g/l | 28 | 25 |
| Alanine aminotransferase (5–55), iu/l | 40 | 61 |
| Aspartate aminotransferase (5–38), u/l | 28 | 42 |
| Lactate dehydrogenase (0–240), u/l | 540 | 470 |
| Creatinine (45–120), µmol/l | 80 | 64 |
| Creatine kinase (25–175), u/l | 50 | 30 |
| eGFR, ml/min/1·73 m2 | 85 | >90 |
| Troponin T (0–14), ng/l | 60 | 29 |
| C‐reactive protein (0–5), mg/l | 186 | 153 |
| Serum ferritin (30–400), µg/l | 1678 | 2123 |
| Procalcitonin (0·02–0·05), µg/l | 0·2 | 0·28 |
| NT‐proBNP, pg/ml | 2375 | 1178 |
| Fibrinogen (2·0–5·0), g/l | 4·3 | 7·4 |
| D‐dimer | 12 838 | 32 155 |
| Coagulation testing | ||
| Antithrombin III level (NR: 80–130%) | 60 | 76 |
| Objective thromboembolism | CTPA demonstrating bilateral lobar, segmental and subsegmental pulmonary embolism | CTPA demonstrating bilateral multiple, linear thrombus in the segmental and subsegmental branches of the upper and lower lobar branches of the pulmonary artery |
| Anticoagulation at the point of thromboembolism | Systemic intravenous heparin | Subcutaneous low‐molecular‐weight heparin |
| Coagulation intent (dose) | Therapeutic (2000 u/h) | Prophylactic (40 mg once daily) |
| INR | 1·2 | 1·1 |
| Activated partial thromboplastin time ratio | 1·3* (intended target: 2·0–2·5) | 0·9 (intended target: N/A) |
| Outcome | ||
| Did they require renal replacement therapy? | Yes | No |
| Days of ICU admission | 16 | – |
| Deceased, recovered or ongoing illness | Deceased | Recovered to discharge |
APACHE II, Acute Physiology And Chronic Health Evaluation II; COVID‐19, coronavirus disease 2019; CPAP, continuous positive airway pressure; CTPA, computed tomography pulmonary angiography; eGFR, estimated glomerular filtration rate; ICU, intensive care unit; INR, international normalised ratio; NT‐proBNP, N‐terminal pro‐brain natriuretic peptide; P/F ratio, the ratio of arterial oxygen partial pressure to fractional inspired oxygen; RT‐PCR, reverse transcriptase polymerase chain reaction; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus‐2; WCC, white cell count.
Very labile coagulation, with significant difficulty achieving a heparin dose which would achieve the target range.