Id |
Subject |
Object |
Predicate |
Lexical cue |
T35 |
0-39 |
Sentence |
denotes |
COAGULOPATHY AND THROMBOSIS IN COVID-19 |
T36 |
40-122 |
Sentence |
denotes |
Many patients with COVID-19 develop a clinically significant coagulopathy (7, 32). |
T37 |
123-377 |
Sentence |
denotes |
The coagulopathy associated with COVID-19 is characterized by thrombocytopenia, minor prolongation of prothrombin time (PT) and partial thromboplastin time (aPTT), and elevated serum D-dimer and fibrinogen, consistent with a consumptive coagulopathy (7). |
T38 |
378-668 |
Sentence |
denotes |
This profile is compatible with postmortem examinations of patients with COVID-19 describing severe endothelial injury, microangiopathy, and alveolar capillary microthrombi (2) Endotheliitis directly elicited by SARS-CoV-2 may be the pathophysiologic link to these postmortem findings (39). |
T39 |
669-907 |
Sentence |
denotes |
In addition to laboratory and histopathological evidence of disordered coagulation and endothelial injury, several reports suggest that patients with COVID-19 are at high risk for developing clinically significant large-vessel thrombosis. |
T40 |
908-1258 |
Sentence |
denotes |
Early anecdotal evidence of venous thromboembolism (VTE) in critically ill patients has been confirmed by multiple case series describing high rates of VTE in COVID-19, with incidence estimates ranging between 8% and 54% (18, 22), significantly exceeding those reported in critically ill patients with H1N1 influenza of 2% (36) and sepsis of 5% (30). |
T41 |
1259-1402 |
Sentence |
denotes |
Reports of large-vessel strokes in patients, including those younger than 50 yr, infected with SARS-CoV-2 also suggest hypercoagulability (28). |
T42 |
1403-1564 |
Sentence |
denotes |
Concordantly, a postmortem study of 12 patients positive for COVID-19 found thrombosis in 58% of cases, which was found to be responsible for 25% of deaths (45). |
T43 |
1565-1704 |
Sentence |
denotes |
Taken together, it is likely that COVID-19-associated coagulopathy and thromboses contribute to the morbidity and mortality of the disease. |
T44 |
1705-1924 |
Sentence |
denotes |
However, it is important to recognize that other non-COVID-19 critical illnesses have demonstrated similar evidence of coagulopathy, yet failed to benefit from anticoagulation treatment in randomized controlled studies. |
T45 |
1925-2169 |
Sentence |
denotes |
For example, coagulopathy has been widely recognized as a contributor to organ failure in sepsis, a disease characterized by circulating D-dimer concentrations that approximate levels observed in patients with COVID-19 (Fig. 2; 10, 32, 38, 40). |
T46 |
2170-2427 |
Sentence |
denotes |
However, studies that have targeted this coagulopathy in sepsis with thrombomodulin (40), AT3 (42), tissue factor pathway inhibitor (1), and activated protein C (31) have all failed to improve mortality, despite improving laboratory indexes of coagulopathy. |
T47 |
2428-2556 |
Sentence |
denotes |
These studies suggest that coagulopathy may simply be a consequence of sepsis, as opposed to a key pathogenic driver of disease. |
T48 |
2557-2743 |
Sentence |
denotes |
Alternatively, as discussed below, coagulation may impart both harmful and protective effects within the injured lung, negating any clinical benefit (or harm) from anticoagulant therapy. |
T49 |
2744-2751 |
Sentence |
denotes |
Fig. 2. |
T50 |
2753-2826 |
Sentence |
denotes |
Coagulopathy in sepsis compared with coronavirus disease 2019 (COVID-19). |
T51 |
2827-2966 |
Sentence |
denotes |
Circulating levels of D-dimer, a marker of coagulopathy, have been found to be significantly and similarly elevated in sepsis and COVID-19. |
T52 |
2967-3021 |
Sentence |
denotes |
This panel represents medians and interquartile range. |
T53 |
3022-3030 |
Sentence |
denotes |
Studies: |
T54 |
3031-3118 |
Sentence |
denotes |
Bernard et al. (10), Vincent et al. (40), Tang et al. (38), and Richardson et al. (32). |
T55 |
3119-3187 |
Sentence |
denotes |
NYC, New York City; pts, patients; RCT, randomized controlled trial. |