Coagulopathy twitter!

Lots of interest in this, as lots of anecdotal evidence of prothrombotic state.

Would urge caution though - for now, outside of a trial, make sure all are on prophylactic heparin immediately on admission... (1/n) https://twitter.com/trishgreenhalgh/status/1247577539624796160

Here's an autopsy report on COVID lungs. https://www.preprints.org/manuscript/202002.0407/v4

Primarily this is viral pneumonia (I am not a pathologist). But there are microvascular thromboses AND haemorrhagic infarcts. (2/n)

Prothrombotic state might explain a lot..
- ARDS picture in some patients
- Tendency to right heart failure
- Reports of ischaemic legs, bowel etc
- High D-Dimer as marker of poor outcome

BUT these are also seen with other critical illness including severe pneumonia/sepsis (3/n)

And using anticoagulant therapy in these conditions has never been proven to have an outcome benefit (eg heparin, thrombomodulin, activated protein C, etc). Risks of bleeding complications may negate any clinical benefit (4/n)...

There are some (of course very small) studies in COVID19 that are prompting larger research studies. But for now this observation study from Wuhan suggests improved outcomes in those who received prophylactic heparin. https://onlinelibrary.wiley.com/doi/10.1111/jth.14817 and I would stick with this. (5/5)