SHM Converge Scientific Abstract ePoster Gallery-A Case of Covid Associated Coagulopathy

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This document describes a severe case of COVID-19-associated coagulopathy in an 82-year-old man with no significant past medical history. He presented with worsening shortness of breath, dry cough, fever, hypoxia, and ultimately required ICU care and intubation. Although an earlier COVID test was negative, repeat PCR was positive. Imaging showed bilateral pulmonary opacities and multifocal ground-glass changes consistent with COVID-19 pneumonia.<br /><br />Laboratory studies revealed marked abnormalities suggesting a DIC-like picture: thrombocytopenia, prolonged PT/INR and PTT, very high D-dimer, and critically low fibrinogen, along with schistocytes on peripheral smear. He also had elevated inflammatory markers and worsening renal function. Because of concern for disseminated intravascular coagulation and progressive coagulopathy, he was treated with fresh frozen plasma, cryoprecipitate, and vitamin K. He initially received baricitinib, dexamethasone, and remdesivir, but some therapies were held as kidney function worsened. Despite the severity of illness, he improved with supportive ICU management, was weaned off oxygen, and discharged in stable condition.<br /><br />The discussion emphasizes that COVID-19 can cause a hypercoagulable state, often with elevated D-dimer and thrombocytopenia, but low fibrinogen is less common and may signal a poor prognosis. The authors note that anticoagulation, especially thromboprophylaxis or therapeutic heparin in high-risk patients, may reduce mortality. They also explain proposed mechanisms of COVID-19 coagulopathy, including inflammation-driven cytokine storm, endothelial dysfunction, platelet activation, complement activation, RAAS disruption, hypoxemia, and altered gene expression.

Asset Subtitle

Peter Iskander

Meta Tag

Author List Anthony Iskander, Jiayi Zheng, Peter Iskander, Syed Muhammad Hussain Zaidi

Category Clinical Vignettes

Concept Coagulopathy

Concept Disseminated Intravascular Coagulation

Concept D-dimer

Concept Extended Thromboprophylaxis

Concept Heparin

Distinguished Non-Finalist

Presenter Organization The Wright Center for GME

Presenting Author Peter Iskander

Track Adult

Keywords

COVID-19-associated coagulopathy

disseminated intravascular coagulation

thrombocytopenia

elevated D-dimer

low fibrinogen

acute respiratory failure

ICU intubation

ground-glass opacities

hypercoagulable state

heparin thromboprophylaxis

Coagulopathy

Disseminated Intravascular Coagulation

D-dimer

Extended Thromboprophylaxis

Heparin