How is COVID-19 coagulopathy differentiated from disseminated intravascular coagulation (DIC)?

Updated: Dec 06, 2020
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Severe COVID-19 often features a coagulation/fibrolytic abnormality that is marked by an increase in plasma D-dimer levels, and that may progress to DIC. However, the pathophysiology of coagulopathy with COVID-19 is very different from that of septic DIC [8] ; the coagulopathy is more localized and has distinct differences from classical DIC or thrombotic microangiopathy syndromes. [51] The clinical presentation in COVID-19 coagulopathy is mostly prothrombotic, with venous and even arterial thromboembolism; hemorrhagic complications are uncommon. [51]

On laboratory testing, the combination of increased D-dimer, thrombocytopenia, and prolonged global coagulation tests in COVID-19 coagulopathy mimics the pattern seen in DIC. However, compared with patients with typical DIC, patients with COVID-19 tend to have a relatively mild thrombocytopenia. Furthermore, in patients with the most severe COVID-19, the prothrombin time is only mildly prolonged; in up to 30% of patients with COVID-19, shortening of PT has been reported. [52]  Most patients with COVID-19 coagulopathy will not meet the International Society on Thrombosis and Haemostasis diagnostic criteria for overt DIC. [51]


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