Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2
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LETTER TO THE EDITOR
Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2 Vittorio Pavoni1 · Lara Gianesello2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Highlights • In critically ill patients with SARS-CoV2 pneumonia, an
early anticoagulant prophylaxis should be started in all patients. • Further studies are needed to establish the cut off D-dimer level to switch from anticoagulant prophylaxis to anticoagulant therapy. • The dosage of fibrinolysis inhibitors associated to doppler ultrasound could help the clinicians in the earliness of anticoagulant therapy.
We read with considerable interest the article “Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2” wrote by Yin et al. [1]. In this retrospective study, authors compared coagulation parameters of patients with severe pneumonia induced by SARS-CoV2 and patients with pneumonia induced by other pathogens. They found that patients with pneumonia SARS-CoV2 had higher platelet count than those induced by non-SARS-CoV2. Moreover, in COVID patients when D-dimer exceeding 3.0 µg/mL the mortality was significantly lower in heparin users than nonusers. Therefore, the authors suggested, in patients infected by SARS-CoV-2, a D-dimer value exceeding 3.0 µg/mL (six-fold of upper limit of normal, 6 ULN) as cut off to start the heparin treatment. These results and conclusions allow to make some considerations.
* Lara Gianesello [email protected] 1
Anesthesia and Intensive Care Unit, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
Department of Anesthesia and Intensive Care, Orthopedic Anesthesia, University-Hospital Careggi, Florence, Italy
2
First point, regarding the definition of anticoagulant therapy, in the present study patients received heparin (unfractionated heparin UFH 10,000–15,000 U/day or low molecular weight heparin LMWH 40–60 U/day) according to European guidelines [2] for 7 days or longer. However, it should be noted that this dose is not an “anticoagulant therapy”, but an “anticoagulant prophylaxis”. Second point, the authors did not indicate the severity of illness of critically ill patients (e.g. Sequential Organ Failure Assessment—SOFA): this parameter is very important when comparing two groups in term of mortality and degree of multi-organ dysfunction. Moreover, causes of mortality would be interesting especially in patients who have not received heparin prophylaxis. Third point, in their study, Yin et al. [1] suggested that “only” the patients with markedly elevated D-dimer may benefit from anticoagulant prophylaxis with LMWH. Patients with severe pneumonia induced by SARS-CoV2 presented high D-dimer and fibrin degradation product (FDP) levels [3], which are indices of active blood clot activation. A recent retrospective study [4] showed that older age, D-dimer levels than 1 µg/L, higher level of IL-6 and higher SOFA score on admission were associa
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