COVID-19 Coagulopathy in Caucasian patients

Although the pathophysiology underlying severe COVID-19 remains poorly understood, accumulating data suggest that a lung-centric coagulopathy may play an important role. Elevated D-dimer levels which correlated inversely with overall survival were recently reported in Chinese cohort studies. Critically however, ethnicity has major effects on thrombotic risk, with a 3-4 fold lower risk in Chinese compared to Caucasians and a significantly higher risk in African-Americans. In this study, we investigated COVID-19 coagulopathy in Caucasian patients. Our findings confirm that severe COVID-19 infection is associated with a significant coagulopathy that correlates with disease severity. Importantly however, Caucasian COVID-19 patients on LMWH thrombo-prophylaxis rarely develop overt DIC. In rare COVID-19 cases where DIC does develop, it tends to be restricted to late stage disease. Collectively, these data suggest that the diffuse bilateral pulmonary inflammation observed in COVID-19 is associated with a novel pulmonary-specific vasculopathy which we have termed pulmonary intravascular coagulopathy (PIC) as distinct to DIC. Given that thrombotic risk is significantly impacted by race, coupled with the accumulating evidence that coagulopathy is important in COVID-19 pathogenesis, our findings raise the intriguing possibility that pulmonary vasculopathy may contribute to the unexplained differences that are beginning to emerge highlighting racial susceptibility to COVID-19 mortality.