Table 1.
Summary of patient-specific risk factors, diagnosis, clinical manifestations, and broad management considerations in patients with CAC.
| Pathogenesis of CAC | Diagnosis of CAC | Clinical manifestations | Treatment of CAC |
|---|---|---|---|
|
Serologic factors: - ↑ D-dimer, fibrinogen, prothrombin time, lupus anticoagulant, IL-6 - Endothelial damage via ACE2 and other pathways - ↑ vWF, factor VIII, RAAS activation Patient-specific factors: - Age and comorbidities (malignancy, CHF, HTN, obesity, smoking, metabolic syndrome) Immobility Severity of illness: - ARDS, DIC, CVC related thrombosis |
Laboratory data: D-dimer, fibrinogen, prothrombin time, platelets Additional imaging: - For suspected symptomatic VTE - For diagnosis of arterial thrombosis (MI, stroke, systemic thromboembolism) - In response to sudden changes in laboratory data and/or clinical status - Hypoxia out of proportion to lung pathology on previous imaging |
Cardiac: - Type I (spontaneous) MI - Microvascular obstruction (?) Neurologic: - Stroke Pulmonary: - PE Vascular: - DVT - VTE Hematologic: - DIC Other: - CRRT filter clotting - Clotting of ECMO circuit |
General recommendations: - Prophylaxis dose AC for all patients hospitalized with COVID-19 (LMWH preferred inpatient) - Treatment dose AC for all patients diagnosed with VTE Additional considerations: - Treatment or escalated dose of AC for patients undergoing CRRT or ECMO - Outpatient prophylaxis with rivaroxaban post-discharge in high-risk patients |
AC: anticoagulation; ACE2: angiotensin-converting enzyme-2; ARDS: acute respiratory distress syndrome; CAC: COVID-19 associated coagulopathy; CHF: congestive heart failure; CRRT: continuous renal replacement therapy; CVC: central venous catheter; DIC: disseminated intravascular coagulation; DVT: deep vein thrombosis; ECMO: extracorporeal membrane oxygenation; HTN: hypertension; IL-6: interleukin 6; LMWH: low molecular weight heparin; MI: myocardial infarction; PE: pulmonary embolism; RAAS: renin-angiotensin-aldosterone system; VTE: venous thromboembolism; VWF: von Willebrand factor.