Coagulation and Clotting in COVID-19 - Disseminated Intravascular Coagulopathy (DIC)

In this lesson we take a look at coagulation and the development of disseminated intravascular coagulopathy (DIC) in patients with COVID-19. One thing we are seeing frequently in these patients is this hyper coagulable state which is a driver of poorer outcomes and ultimately mortality.

I start off talking about what it is that is happening in the body leading to these coagulopathies. While we aren't quite sure of the exact mechanisms, we believe it is probably multifactorial, and have a few ideas. First we believe that just the hyper inflammatory state contributes to increased coagulation in these patients, along with localized endothelial tissue damage as a result of the virus binding with the cells. This all can contribute to activation of the clotting cascade. I then talk about the Renin-Angiotensin System and do a quick review through the normal pathophysiology of this system, identifying key parts that we believe may play a role. From there I incorporate how SARS-CoV2 changes this pathophysiology and could potentially contribute to coagulopathy and clotting. Finally I mention about the lack of mobilization in these patients increasing their risk for clotting, such as DVT and PEs.

We move on to talk about the lab values that we want to keep an eye on from our D-Dimer, Fibrinogen, as well as coagulation panels from PT/INR, aPTT and TEG. I also mention about the elevation in Factor VII and VWF.

Finally we talk about some of the things we are doing and trying to use to either prevent or treat these coagulopathies. Aggressive DVT prophylaxis seems to be important in all patients, but there seems to be a large belief that therapeutic heparin anticoagulation, especially in the presence of elevated D-Dimer, can potentially improve outcomes and improve mortality. I also talk about the potential benefit of ACE Inhibitors.

Hopefully, after this lesson, you will have a better understanding of what is happening in your patients with COVID-19, related to coagulation and clotting.

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0:00 Intro
1:34 Overview
2:34 What is Happening?
7:26 Labs
8:57 Prevent/Treat
13:20 Conclusion

[ICUAdvantage]

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[mufasa]

I am a brand new nurse in the ICU. And 90% of our patients are Covid patients. This video series helps alot.

[chilla]

My boyfriend suffered 2 massive strokes on bolth sides of his brain he went to the hospital diagnosed with covid and within 2 days this happened. He is only 46. We just had a baby, he is left basically in a vegetative state on a trach his family wouldnt let him go in peace. I am just here trying to research what and why this happened to him. I miss him so much. Thanks for the video.

[shilohpeterson]

Thank you. Interestingly enough I came down with Covid when I was 8weeks pregnant. Got through it with clinically mild symptoms and no known damage to the fetus so far (18 weeks now). OBGYN told me to start taking low dose aspirin because apparently they are seeing some cases of restricted uterine growth from micro clotting in the placenta. Just thought that was interesting!

[loayalnasser]

More more please I really love your method actually your explanation is incredibly interesting

[RNBSN]

Thanks for another amazing video! Any videos on T1DM and Peds?

[zsqjkom]

Is DIC S D major complication in post covid 19?

[dr.mahboobullahshafiq]

Thank you Sir, Very useful series of protocols for Covid19

[ryanfarkas]

Can you please share links to studies showing benefits for therapeutic doses of anticoags vs prophylactic doses in COVID pts.? I still have MDs who resist this trend. Thanks!

[mymonster]

Angiogenesis in Pulmonary vasculature may be stopped by Avastin and similar chemotherapeutics.

[elizabethmonje]

Thank you for putting videos out there will educate us when covid hit my home my son and I we practice prevention but really didn't know anything about the virus my son went to Banner hospital emergency room because he was scared they told him he had pneumonia gave him antibiotics and prednisone by the third day of taking the meds had to call 911 the hospitalized them incubated him and he died no shocked had to find answers went to the hospital information portal and I found that they had given him a wrong diagnosis it's in the report 40 years old no underlying conditions breathing good the doctor checked his lungs at the lungs were clear his x-ray said they were not sure vague but the last doctor took it up on himself to say covid pneumonia she forgot to look at the details she was negligent she was in a hurry to get them out and it cost my son's life her negligence I'm not saying that all doctors are negligent I'm saying that this one was negligent so all I do is when the people check out your hospital make sure it's a good one don't go to the hospital unless you have to do your research lawyers will not touch covid cases so I can do is want people

[kainatayub]

what is the resource for information between 4-5 min mark (RAAS system)

[brodyforwin]

Really informative ! Thz u so much sir.

[hannahasmr]

Hey! So quick question, would you recommend all people with a covid-19 infection take some form of anticoagulation (like baby asa), or just those who are hospitalized and have the cytokine storm, etc. I have a mild case and am almost 2 weeks out and a coworker told me to take aspirin, which I really don't think I need. I have no symptoms of DVT/PE.

[elpedro]

I’m sorry, but why are factor 7 and VWF elevated, if we have too much coagulation?

[sachinrao]

Age 43 yrs Male - What is the treatment for high ddimer post covid ? I got covid in late April and was discharged in 2nd week of May. I lost my fistula during covid as it clotted . Currently dialyzing thru permacath. My ddimer levels haven't normalized even 6 mths after recovering from Covid. They are at 2000 (normal less than 500) right now. I'm under dialysis and my neph has prescribed Eliquis 2.5 mg once a day on non dialysis days (I'm on dialysis since the last 8 years). I've been having this tablet for the past 4 months but ddimer has not reduced . Have also tried a course of 6 clexane 40 injections but that had no effect. Any advice ?Thanks

[shadisrm]

I have a question and I will be very thankful if you answer that: how can we estimate the number and the size of thrombosis in a alveolus capillary?

[gary]

I had 1.19 ug/mL when I was hospitalized. How bad is that?

[BigDaddyCane]

If a D-Dimer increases day by day 1000, 1400, 1600 etc., what does this indicate?