{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T08:08:32Z","timestamp":1770278912895,"version":"3.49.0"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T00:00:00Z","timestamp":1608163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>A significant proportion of patients with coronavirus disease 19 (COVID-19) suffer from excessive coagulation activation and coagulopathy which is associated with an increased risk of venous and arterial thromboembolism and adverse outcome. Our study investigates coagulation markers and the incidence of thromboembolic events in COVID-19 patients receiving recommended anticoagulation strategies.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>In a retrospective single-center analysis at the University Hospital Zurich, Switzerland, we investigated 31 adult COVID-19 patients between April 6<jats:sup>th<\/jats:sup>and May 13<jats:sup>th<\/jats:sup>, 2020 and with at least one laboratory assessment of the coagulation markers prothrombin time\/Quick, thrombin time, fibrinogen and D-dimers. For antithrombotic prophylaxis low-molecular-weight-heparin or unfractionated heparin was administered and two patients with heparin-induced thrombocytopenia received argatroban.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>We analyzed 31 patients (68% male, mean age 60\u00b1 SD 15 years). 22 (71%) of these required intensive care unit treatment, 5 (16%) were hospitalized in a ward, and 4 (13%) were outpatients. Mean fibrinogen levels were markedly elevated to 6.4\u00b1 SD 1.8g\/l, with a peak in the third week of the disease and no significant decrease over time. D-dimers were elevated to a mean value of 5.1\u00b14.4mg\/l with peak levels of 6.8\u00b15.3mg\/l in the fourth week of disease, and a subsequent decrease. Platelet count (308\u00b1136G\/l) and PT\/Quick (85\u00b122%) showed no significant changes over time. Sensitivity analyses for patients treated in the ICU showed that D-dimer levels were higher in this group. The results of other sensitivity analyses were comparable. Thromboembolic events were diagnosed in 4 (13%) patients and 5 (16%) patients died during the observation period.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>We find coagulation alterations in COVID-19 patients indicating significant hypercoagulability. These alterations are visible despite antithrombotic treatment, and peak around week 3\u20134 of the disease.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0243409","type":"journal-article","created":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T19:43:03Z","timestamp":1608234183000},"page":"e0243409","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Coronavirus-induced coagulopathy during the course of disease"],"prefix":"10.1371","volume":"15","author":[{"given":"Marie Sophie","family":"Friedrich","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan-Dirk","family":"Studt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Braun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donat R.","family":"Spahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9105-8328","authenticated-orcid":true,"given":"Alexander","family":"Kaserer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,12,17]]},"reference":[{"issue":"10229","key":"pone.0243409.ref001","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"F Zhou","year":"2020","journal-title":"Lancet"},{"issue":"5","key":"pone.0243409.ref002","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1111\/jth.14810","article-title":"ISTH interim guidance on recognition and management of coagulopathy in COVID-19","volume":"18","author":"J Thachil","year":"2020","journal-title":"J Thromb Haemost"},{"key":"pone.0243409.ref003","article-title":"Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China","author":"C Wu","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"10234","key":"pone.0243409.ref004","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Z Varga","year":"2020","journal-title":"Lancet"},{"issue":"7","key":"pone.0243409.ref005","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1515\/cclm-2020-0188","article-title":"Prominent changes in blood coagulation of patients with SARS-CoV-2 infection","volume":"58","author":"H Han","year":"2020","journal-title":"Clin Chem Lab Med"},{"issue":"4","key":"pone.0243409.ref006","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1111\/jth.14768","article-title":"Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia","volume":"18","author":"N Tang","year":"2020","journal-title":"J Thromb Haemost"},{"issue":"10223","key":"pone.0243409.ref007","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet"},{"key":"pone.0243409.ref008","first-page":"w20247","article-title":"Thromboprophylaxis and laboratory monitoring for in-hospital patients with COVID-19\u2014a Swiss consensus statement by the Working Party Hemostasis","volume":"150","author":"A Casini","year":"2020","journal-title":"Swiss Med Wkly"},{"key":"pone.0243409.ref009","unstructured":"Gesellschaft f\u00fcr Thrombose- und H\u00e4mostaseforschung. 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