VPB0105 - COVID-19 Coagulopathies - Highlights On 2020-2021 Reported Data

Background: COVID-19 pandemic has evolved dramatically over the past two years and literature on COVID coagulopathy has been overwhelming. Understanding literature and assessing the quality of data available is a challenge which is furthermore complicated by the difficulty in defining the ‘waves of infection’ across the globe.

Aims: To provide highlights on literature regarding coagulation impairments, thrombotic complications, and anticoagulation use in severe COVID-19 patients, over the past 2 years of the pandemic.

Methods: Performed a systematic search on MEDLINE, EMBASE and EPUB Ahead of Print AND Other Non-Indexed Citations (from inception to 18th July 2021). Studies were eligible for inclusion if written in English, reporting severe COVID-19/ hospitalized patients and reporting coagulopathy data and thrombotic complications. Articles had to be published in journals with impact factor 3 or above. Data abstracted on country, total number of patients, age and sex, coagulation parameters, thrombotic complications, and anticoagulation data.

Results: Identified 62 studies (PRISMA in Figure 1). A total of 18,581 patients reported from 16 different countries (Figure 2) published between March 2020 to July 2021 were included in this review. Coagulation lab parameters were reported in most studies with considerable heterogeneity on data reported. A key finding is a pro-coagulant profile with hypercoagulability more pronounced in ICU patients. Controversy existed around thrombocytopenia in association with severe or late disease. Elevated fibrinogen was reported in 37/41 (90%) studies. Elevated D-dimer was consistently reported and was predictive of thrombosis and poor outcome. 46 (74%) studies reported VTE which occurred despite guideline-recommended thromboprophylaxis. Anticoagulation was reported in all studies, but practices were diverse.

Conclusion(s): Evident heterogeneity of clinical and laboratory findings of reported studies with inconsistent reporting on coagulation parameters, units of measurement and relationship to disease outcomes. This study can help investigators carefully design future studies related to coagulopathy in COVID-19.