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StuttgartIn a "Letter to the Editor" published recently in the medical journal "Thrombosis and Haemostasis" (Thieme, New York, 2020), clinical pathologists point out that COVID-19 has an effect on the blood coagulation of patients. Surveys indicate that the D-dimer value of infected patients is increased, partly even to threatening levels in line with the severity of the medical condition. For this reason, the authors recommend additional examinations to investigate whether patients suffering severely from the disease may profit from accompanying treatment with anticoagulant medication.

When referring to D-dimers, medical specialists are describing fission products of fibrin, an important protein for blood coagulation. If clotting occurs inside the body and is dissolved, D-dimers are formed. For this reason, the D-dimer value is generally determined in case of any suspicion of pulmonary embolism, leg vein thrombosis or disseminated intravascular coagulation (DIC). In case of DIC, the blood coagulation system is overly activated. As a consequence, the concentration of coagulation factors in the blood is reduced leading to a generally increased risk of haemorrhage.

Professor Giuseppe Lippi is the Laboratory Director at the University Hospital of Verona (Italy). In cooperation with Professor Emmanuel J Favaloro, Head of the Haemostasis laboratories at the Institute of Clinical Pathology and Medical Research at Westmead Hospital in Sydney (Australia), he has examined five current surveys on the D-dimer value of patients infected with COVID-19. "All indicate that the D-dimer value of patients infected with COVID-19 is often increased. "In patients suffering severely from the disease, comparatively higher values were measured in comparison to patients with a milder form of the disease," as explained in the article in the medical journal "Thrombosis and Haemostasis". In patients suffering severely from the disease, up to 9 times higher D-dimer values were measured in comparison to infected patients who did not require intensive medical care and ventilation. The majority of patients who have died due to COVID-19 were suffering from DIC or other forms of severe coagulopathy.

For this reason, Lippi and Favaloro have recommended further studies focusing on the D-dimer values of patients infected with COVID-19. Patients suffering severely from the disease may profit from continuous monitoring of the values and coordinated administering of anticoagulant medication.

G. Lippi and E. Favaloro:
D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis
Thrombosis and Haemostasis 2020; published online as "Letter to the Editor" on 3rd April 2020

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