venous thromboembolism | The Journal of Critical Care Medicine

Hypercoagulopathy in Overweight and Obese COVID-19 Patients: A Single-Center Case Series

Azza Sarfraz^1,2, Zouina Sarfraz^1,3, Aman Siddiqui^1,4, Ali Totonchian⁴, Syed Hashim Abbas Ali Bokhari⁵, Hafiza Hussain³, Muzna Sarfraz¹, Gaurav Patel¹, Muhammad Hassaan Amjad⁶, Sameer Saleem Tebha¹, Ivan Cherrez-Ojeda^7,8, Patrick Dreyer¹, Harshad Amin¹, Jack Michel¹

1 Larkin Health System, South Miami, FL, USA
2 Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
3 Research and Publications, Fatima Jinnah Medical University, Lahore, Pakistan
4 Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
5 School of Medicine, The Aga Khan University, Karachi, Pakistan
6 Neurosurgery, Sir Ganga Ram Hospital, Lahore, Pakistan
7 Allergy and Pulmonology, Universidad de Especialidades Espíritu Santo, Ecuador
8 Respiralab Research Center, Guayaquil, Ecuador

DOI: 10.2478/jccm-2021-0032

A case series is presented of five overweight or obese patients with confirmed coronavirus disease 2019 (COVID-19) in South Miami, Florida, United States. A multitude of coagulation parameters was suggestive of a hypercoagulable state among the hospitalized COVID-19 patients. This article reports various manifestations of hypercoagulable states in overweight and obese patients, such as overt bleeding consistent with disseminated intravascular coagulation, venous thromboembolism, gastrointestinal bleeding as well as retroperitoneal hematoma. All of the required admission to the intensive care unit and subsequently patients died. The characteristics of COVID-19-associated coagulopathy are atypical and warrant a further understanding of the pathophysiology to improve clinical outcomes, specifically in overweight or obese patients.

Anticoagulation in COVID – 19: An Update

Nishant R Tiwari¹, Khalid I Khatib², Subhal B Dixit³, Prajay K Rathore⁴, Sameer Melinkeri⁵, Abhijeet Ganapule⁶, Kapil S Borawake⁷, Ujwala Mhatre⁸

1 Byramjee Jeejeebhoy Medical College and Sassoon General Hospital, Pune, Maharashtra, India
2 Smt Kashibai Navale Medical College and General Hospital, Pune, India
3 Sanjeevan Hospital, Pune, India
4 Danbury Hospital, Danbury, USA
5 Deenanath Mangeshkar Hospital and Research Centre, Pune, India
6 Niche Hematology Care, Kolhapur, India
7 Prayag Hospital, Pune, India
8 Nanavati Hospital, Mumbai, India

DOI: 10.2478/jccm-2020-0033

The novel coronavirus disease, 2019 (COVID – 19) evolved as an unprecedented pandemic. The severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) infection has been associated with significantly deranged coagulation parameters and increased incidence of thrombotic events. Deranged coagulation parameters, such as D-dimers and fibrin degradation products, can indicate a poor prognosis, and their measurement will help stratify the patients according to the disease severity, need of intensive care unit admission, and prediction of the clinical course. Gaps in understanding the natural history of the disease cause difficulties in tailoring therapies and optimizing the management of patients. Lack of specific treatment further complicates this situation. While thrombotic events can cause significant morbidity and mortality in patients, a focused approach to the prevention and treatment of venous thromboembolism (VTE) can, to a great extent, decrease the disease burden caused by thrombotic diseases. Pharmacological prophylactic anticoagulants and mechanical therapies such as pneumatic compression devices can help prevent venous thromboembolism and other thrombotic events. Thrombotic events due to COVID-19, their prevention and management, are the focus of this paper, with the prospect of providing insights into this relatively unexplored area.