Coagulation and Clotting in COVID-19 - Disseminated Intravascular Coagulopathy (DIC)

In this lesson we take a look at coagulation and the development of disseminated intravascular coagulopathy (DIC) in patients with COVID-19. One thing we are seeing frequently in these patients is this hyper coagulable state which is a driver of poorer outcomes and ultimately mortality.

I start off talking about what it is that is happening in the body leading to these coagulopathies. While we aren't quite sure of the exact mechanisms, we believe it is probably multifactorial, and have a few ideas. First we believe that just the hyper inflammatory state contributes to increased coagulation in these patients, along with localized endothelial tissue damage as a result of the virus binding with the cells. This all can contribute to activation of the clotting cascade. I then talk about the Renin-Angiotensin System and do a quick review through the normal pathophysiology of this system, identifying key parts that we believe may play a role. From there I incorporate how SARS-CoV2 changes this pathophysiology and could potentially contribute to coagulopathy and clotting. Finally I mention about the lack of mobilization in these patients increasing their risk for clotting, such as DVT and PEs.

We move on to talk about the lab values that we want to keep an eye on from our D-Dimer, Fibrinogen, as well as coagulation panels from PT/INR, aPTT and TEG. I also mention about the elevation in Factor VII and VWF.

Finally we talk about some of the things we are doing and trying to use to either prevent or treat these coagulopathies. Aggressive DVT prophylaxis seems to be important in all patients, but there seems to be a large belief that therapeutic heparin anticoagulation, especially in the presence of elevated D-Dimer, can potentially improve outcomes and improve mortality. I also talk about the potential benefit of ACE Inhibitors.

Hopefully, after this lesson, you will have a better understanding of what is happening in your patients with COVID-19, related to coagulation and clotting.

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0:00 Intro
1:34 Overview
2:34 What is Happening?
7:26 Labs
8:57 Prevent/Treat
13:20 Conclusion

Видео Coagulation and Clotting in COVID-19 - Disseminated Intravascular Coagulopathy (DIC) канала ICU Advantage