Published in:
01-11-2021 | COVID-19
International COVID-19 thrombosis biomarkers colloquium: COVID-19 diagnostic tests
Published in: Journal of Thrombosis and Thrombolysis | Issue 4/2021
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Hypercoagulability is a hallmark of COVID-19 and is accompanied by microvascular thrombosis, mainly in small pulmonary and renal vessels, and an elevated risk of venous thromboembolism, stroke and myocardial injury [1, 2]. Unlike conventional sepsis, a mortality benefit associated with anticoagulation therapy suggests an important role of hypercoagulability in COVID-19 outcomes [3]. In the absence of robust evidence from randomized clinical trials, physicians are often implementing institutional guidelines for antithrombotic therapy. Various consensus guidelines and recommendations have also been written addressing specific laboratory functional analyses to facilitate clinical decision-making (Table 1) [4‐8]. Both prophylactic and therapeutic doses of anticoagulants, depending on the severity of the disease, have been used in an attempt to attenuate the risk of thrombosis [4‐8]. Unlike other thrombotic diseases with longer disease progression, COVID-19 has a very rapid progression, reaching peak severity within weeks. Preliminary studies suggest an inadequate effect of prophylactic anticoagulant therapy in a substantial percentage of patients. Therefore, monitoring with coagulation and platelet function tests may optimize antithrombotic therapy management and reduce thrombotic risk during the critical initial course of the disease.
Table 1
Major recommendations for coagulation tests
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Centers for Disease Control and Prevention (CDC) guidelines [4]
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Hospitalized adults with COVID-19 should receive VTE prophylaxis per the standard of care; hematologic and coagulation parameters are commonly measured, although there is insufficient data to recommend for or against using laboratory values to guide management
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International Society for Thrombosis and Haemostasis’s interim guidance (ISTH-IG) [5]
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Monitoring D-dimer, partial thromboplastin time (PTT), platelet count, and fibrinogen levels for all patients who present with COVID-19 as the measurements may be helpful as more aggressive critical care treatment is warranted and experimental therapies should be considered
(D-dimer markedly raised three- to fourfold, prothrombin time prolonged, platelet count < 100 × 109, and fibrinogen < 2.0 g/L)
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American Society of Hematology (ASH) [6]
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Recommends monitoring D-dimer, PTT, platelet count, and fibrinogen
Anti-Xa activity assay, not aPTT, is recommended to monitor unfractionated heparin therapy
Thromboelastography and rotational thromboelastometry are currently under investigation for COVID associated coagulopathy and should not be used routinely to guide management
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American College of Chest Physicians (ACCP) [7]
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Insufficient data to guide clinical practice for coagulation tests
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American College of Cardiology (ACC) [8]
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Regular monitoring of platelet count, prothrombin time, D-dimer, and fibrinogen is important to diagnose worsening coagulopathy
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