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15 april 2020

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19 - NEJM

6-4-2020; https://www.nejm.org/doi/full/10.1056/NEJMc2007575?query=featured_coronavirus
By: Zhang, et al. 

Describe a covid-19 patient with significant coagulopathy, antiphospholipid antibodies and multiple infarcts


  • Antiphospholipid coagulopathy might be associated with covid-19


  • Three patients on a special covid-19 ICU had significant coagulopathy, antiphospholipid antibodies and multiple infarcts
  • Case of a 69 year old with history of hypertension, DM, and stroke is described.
  • Presentation: cough, fever, dyspnea, diarrhea, and headache.
  • RT-PCR detected SARS-CoV-2 → supportive treatment on which the illness progressed to respiratory failure needing invasive ventilation
  • Patients showed evidence of ischemia of both lower limbs and several fingers. CT-cerebrum showed bilateral infarction. 
  • Prothrombin time, thromboplastin time, D-dimer and fibrinogen were elevated. Subsequent testing showed anticardiolipine IgA antibodies aswell as anti-beta2-glycoproteine I IgA en IgG antibodies
  • Two other covid-19 patients presented similarly.