Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
    • Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
      • 1-Minute Consult
      • Commentary
      • Current Drug Therapy
      • Editorial
      • Guidelines to Practice
      • Interpreting Key Trials
      • Letter to the Editor
      • Review
      • Smart Testing
      • Symptoms to Diagnosis
      • The Clinical Picture
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
  • COVID-19
    • Curbside Consults Overview
    • Pulmonary/ICU
    • Patient Subsets & Specific Organ Involvement
    • Therapies
    • Imaging & Procedures
    • Patients with Underlying Disease
    • Virus Background & Testing
    • Healthcare System Practice
  • Conference Coverage
    • ASH Annual Meeting
    • AHA Sessions 2020
    • IDWeek 2020
    • CHEST 2020
    • ADA 2020
    • ACC 2020
  • Advertise
    • Media Kit
    • Contact
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
    • Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
  • COVID-19
    • Curbside Consults Overview
    • Pulmonary/ICU
    • Patient Subsets & Specific Organ Involvement
    • Therapies
    • Imaging & Procedures
    • Patients with Underlying Disease
    • Virus Background & Testing
    • Healthcare System Practice
  • Conference Coverage
    • ASH Annual Meeting
    • AHA Sessions 2020
    • IDWeek 2020
    • CHEST 2020
    • ADA 2020
    • ACC 2020
  • Advertise
    • Media Kit
    • Contact
Letters to the Editor

COVID-19 coagulopathy

Anup Katyal, MD
Cleveland Clinic Journal of Medicine December 2020, 87 (12) 712; DOI: https://doi.org/10.3949/ccjm.87c.12001
Anup Katyal
St. Louis, MO
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • PDF
Loading

To the Editor: I read with keen interest the article “Coagulopathy in COVID-19: Manifestations and management” in the August issue.1 While I agree with the need for prophylaxis against venous thromboembolism (VTE) in patients admitted with COVID-19 and the need for therapeutic anticoagulation for confirmed VTE, I am skeptical of high-intensity prophylaxis for patients with D-dimer levels of 3.0 μg/mL or higher.

The American College of Chest Physicians, in their updated guidelines on prevention, diagnosis, and treatment of VTE in patients with COVID-19,2 state, “In critically ill patients with COVID-19, we suggest current standard dose anticoagulant thromboprophylaxis over intermediate ([low-molecular-weight heparin twice a day] or increased weight-based dosing) or full treatment dosing, per existing guidelines.”

Also, Al-Samkari et al3 performed a retrospective analysis of 400 COVID-19 patients managed with prophylactic anticoagulation, in whom the rate of radiographically confirmed VTE was 4.8% and the overall bleeding rate was 4.8%. In 144 critically ill patients, the rate of radiographically confirmed VTE was 7.6%, and the bleeding rate was 5.6%. Elevated D-dimer levels predicted bleeding as well as thrombotic complications, suggesting one should exercise caution in using the higher VTE prophylaxis dose.

Randomized clinical trials are needed to determine the optimal dose and course of thromboprophylaxis in patients with COVID-19.

  • Copyright © 2020 The Cleveland Clinic Foundation. All Rights Reserved.

REFERENCES

  1. ↵
    1. Mucha SR,
    2. Dugar S,
    3. McCrae K,
    4. Joseph D,
    5. Bartholomew J,
    6. Sacha GL,
    7. Militello M
    . Coagulopathy in COVID-19: manifestations and management. Cleve Clin J Med 2020; 87(8):461–468, doi:10.3949/ccjm.87a.ccc024
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Moores LK,
    2. Tritschler T,
    3. Brosnahan S, et al
    . Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019. Chest guideline and expert panel report. Chest 2020; 158(3):1143–1163. doi:10.1016/j.chest.2020.05.559
    OpenUrlCrossRef
  3. ↵
    1. Al-Samkari H,
    2. Leaf RSK,
    3. Dzik WH, et al
    . Covid-19 and coagulation: bleeding and thrombotic manifestations of SARS-Cov-2 infection. Blood 2020; 136(4):489–500. doi:10.1182/blood.2020006520
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

Registration is Now Required for Free Access to CCJM Content

Register once and log in for full access to articles and content. Click “Register” in the upper right corner and follow the simple instructions to create a new account.

If you are using a mobile device, click on the settings icon to access the Register link.

In this issue

Cleveland Clinic Journal of Medicine: 87 (12)
Cleveland Clinic Journal of Medicine
Vol. 87, Issue 12
1 Dec 2020
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
COVID-19 coagulopathy
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
15 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
COVID-19 coagulopathy
Anup Katyal
Cleveland Clinic Journal of Medicine Dec 2020, 87 (12) 712; DOI: 10.3949/ccjm.87c.12001

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
COVID-19 coagulopathy
Anup Katyal
Cleveland Clinic Journal of Medicine Dec 2020, 87 (12) 712; DOI: 10.3949/ccjm.87c.12001
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Linkedin Share Button

Jump to section

  • Article
    • REFERENCES
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Dexamethasone or hydrocortisone in COVID-19?
  • In Reply: Assessing stable coronaryartery disease
  • In Reply: COVID-19 coagulopathy
Show more Letters to the Editor

Similar Articles

Subjects

  • Infectious Diseases
  • Preventive Care
  • Pulmonology
  • Vascular Medicine
  • Hospital Medicine
  • Hematology
  • Drug Therapy
  • Critical Care

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit
  • Advertise Contact

Info For

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • Advertisers
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2021 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire