Response to 'Pulmonary thrombosis in 2019-nCoV pneumonia?'

REPLY TO THE COMMENT

We appreciate the opportunity to respond to the comments by Dr. Marongiu et al. They presented only laboratory findings of disseminated intravascular coagulation (DIC), but no bleeding was mentioned, indicating that there was not overt DIC in our patients; instead, the abnormal laboratory findings could be an expression of local DIC (ie, a pulmonary vascular thrombosis). Thus, they suggested anticoagulant treatment in patients with coronavirus disease 2019 (COVID‐19).

First, bleeding is less common than thrombosis and presents late in DIC induced by infection, and the site of bleeding is sometimes hard to find (eg, brain, intra‐abdominal). We suggest the International Society of Thrombosis and Haemostasis diagnostic criteria rather than just relying on clinical manifestation for DIC diagnosis. In fact, because of neglect or lack of available coagulation tests, the diagnosis of DIC is often delayed until bleeding from multiple sites occurs.

We agree with Dr. Marongiu et al that pulmonary vascular thrombosis may exist in some severe COVID‐19 cases, the pulmonary inflammatory reaction and hypoxemia resulting from SARS‐CoV‐2 infection can lead to hypercoagulability. However, because DIC is an acquired syndrome characterized by systemic intravascular activation of coagulation, leading to deposition of fibrin in the circulation, we disagree with the contradictory concept of “local DIC.” Once patients meet the diagnostic criteria of DIC, multiple organ dysfunction resulting from microthrombus should be considered, not only in the lung, although it may be the most affected organ.

Finally, anticoagulant treatment is a reasonable choice for preventing DIC and venous thromboembolism in COVID‐19. However, the activation of blood coagulation is essential in counteracting virus infections ; on the other hand, patients meeting the diagnostic criteria of overt DIC may have illness progression that no longer benefits from anticoagulant treat. Hence, it is important to identify patients who can benefit from anticoagulants using the criteria of sepsis‐induced coagulopathy suggested by International Society of Thrombosis and Haemostasis, markedly elevated D‐dimer on admission and so on can also be considered. We are retrospectively analyzing the association of anticoagulant treatment with outcome in severe COVID‐19 patients of our hospital, and hope the results will contribute to the management of COVID‐19 in the future.

CONFLICT OF INTEREST

None declared.