The International Society on Thrombosis and Haemostasis (ISTH) has proposeda new category to detect the earlier phase of sepsis-associated disseminatedintravascular coagulation (DIC), called sepsis-induced coagulopathy. Thecriteria included platelet count, prothrombin time and Sequential OrganFailure Assessment (SOFA) score.(1) Patients with sepsis and extensive formsof DIC may develop overt thromboembolic complications, or clinically lessapparent microvascular clot formation that may contribute to multiple organfailure.(2) Activation of the vascular endothelium, platelets, and leukocytesresults in dysregulated thrombin generation, both systemically and locally,in the lungs of patients with severe pneumonia, leading to deposition offibrin with subsequent tissue damage and microangiopathic pathology.(3)Severe lung inflammation in coronavirus disease 2019 (COVID-19) has beensuggested to be associated with upregulation of pro-inflammatory cytokines.Moreover, based on the immune-mediated thrombosis model that highlightsthe relation between the immune system and thrombin generation, blockingthrombin through heparin could reduce the inflammatory response caused byCOVID-19.(4) In a recent publication, Tang et al., assessed the 28-day mortalityin heparin users and non-users, among severe COVID-19 patients, at differentrisks of developing sepsis-induced coagulopathy. A total of 449 patients wereclassified as severe COVID-19 and 99 patients received heparin; in that, 94were treated with low-molecular-weight heparin (LMWH), and five withunfractionated heparin (UFH). The authors observed in patients with sepsisinducedcoagulopathy score ≥4 or D-dimer 3μg/mL that heparin users hadlower 28-day mortality rates than non-users. They concluded anticoagulanttherapy appeared to be associated with better prognosis in severe COVID-19patients meeting sepsis-induced coagulopathy criteria or with markedlyelevated D-dimer.
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