ISTH interim guidance on recognition and management of coagulopathy in COVID-19

Abstract The novel corona virus infection (now classified as COVID-19), first identified in December 2019 in Wuhan, China, has contributed to significant mortality in several countries with the number of infected cases increasing exponentially worldwide.1 The majority of the most severely ill patients initially present with single organ failure (i.e. respiratory insufficiency) but some of them progress to more systemic disease and multiple organ dysfunction. One of the most significant poor prognostic features in those patients is the development of coagulopathy.2 In patients who develop sepsis from various infectious agents, development of coagulopathy is one of the key and persistent features which is associated with poor outcomes.3 In this context, the role of International Society of Thrombosis and Haemostasis (ISTH) would be crucial in guiding health care professionals how to manage the coagulopathy of COVID-19. A simple and easily follow-able algorithm for the management of COVID-19 coagulopathy would currently be useful in both the well-resourced and less-resourced settings as a guide in managing this complication. This pragmatic statement should clearly be considered as an interim guidance since the clinical experience of managing this pandemic is increasing. The authors are certain that this statement will be modified with developing knowledge and therapeutics in managing COVID-19. The aim of this guidance document is to provide a risk stratification at admission for a COVID-19 patient and management of coagulopathy which may develop in some of these patients, based on easily available laboratory parameters.