@NEJM Advisory: Blood clotting in small blood vessels is a symptom of severe #COVID_19. It can be detected by a rise in D-dimer, a protein fragment not normally in blood, but is released from degrading clots... 1/6

Physician guidance: Upon presentation of #Covid_19, measurements advised, in order of importance, are of D-dimer, prothrombin time, and platelet counts. @NEJM @JWatch https://tinyurl.com/wqzjh59  2/6

Nonsurvivors have developed disseminated intravascular coagulation (clots in small blood vessels) around day 4. Significant worsening at days 10 & 14 also reported. 3/6

A 3-4-fold increase in D-dimer in #Covid_19 patients may signal the need for hospital admission without other clear indicators of severity. This will, of course, depend on bed availability. 4/6

Panel advises the use of prophylactic dose low-molecular-weight heparin, a blood thinner, in #Covid_19 patients, unless there's active bleeding or a platelet count less than 25×10^9/L; hope is this will protect against blood vessel blockage by a detached clot 5/6

Disclaimer from @JWatch article: "useful for hematologists, hospitalists, emergency department physicians, & critical care specialists...management strategies will evolve as knowledge increases." Pls. refer to original Apr 6 article in this thread. 6/6