COVID-19-associated coagulopathy: a clinical case

Background. Comorbid patients with a new coronavirus disease (COVID-19) often have thrombosis or bleeding in different periods of the disease. Early diagnosis of these complications and adequate therapy of these patients are complicated due to the peculiarities of the disease in comorbidity. Anticoagulation regimens in patients with COVID-19 are still unclear. The protocol of efficacy and safety the intermediate or therapeutic dose of low-molecular-weight heparins is not clear and complete. It is very important to organize an individual approach for correction of the anticoagulants doses, taking into account the coagulation tests and the activity of inflammatory markers.

Clinical case description. We report a 71-year-old white male with COVID-19 pneumonia. Acute respiratory distress syndrome and atrial fibrillation were diagnosed in ten days of the disease. Therapeutic anticoagulation was started upon the admission. As early as in the 20th day of the disease a gluteal hematoma developed. Hence, prophylactic regimen of anticoagulation was started, but the worsening of dyspnea at rest, decreasing in SpO2 values to 82% according to pulse oximetry, and thrombelastographic hypercoagulability were observed after two days of such anticoagulation treatment. The patient has been receiving daily low-molecular-weight heparins injections in therapeutic doses for the following two weeks, and then the doctors have switched him to new oral anticoagulants. Patient was discharged to continue ambulatory anticoagulant’s treatment.

Conclusion. It is clear that the optimal choice of anticoagulation strategy in comorbid patients with concomitant COVID-19 remains challenging and requires randomized trials. Until the guidelines develop the effective anticoagulation strategy for various phenotypes of COVID-19 patients, the clinicians’ knowledge, experience and creative thinking will be apply to choose effective anticoagulant’s treatment on individual basis.