key: cord-1012231-yvv3ltoe authors: Lillicrap, David title: Disseminated intravascular coagulation in patients with 2019‐nCoV pneumonia date: 2020-03-24 journal: J Thromb Haemost DOI: 10.1111/jth.14781 sha: 7af1feee1e2f7e771eab2ed22bf299e6ac761e12 doc_id: 1012231 cord_uid: yvv3ltoe nan This account of the involvement of the hemostatic system in severe 2019-nCoV pneumonia will not come as a major surprise to the hemostasis community, for which the involvement of sepsis as an initiator of DIC is very well documented. 8 Nevertheless, whether this particular virus is more prone to DIC development will need to be followed closely as this epidemic evolves. The pathophysiology of DIC is complex and multifactorial, involving an interplay between cellular and plasmatic elements of the hemostatic system and components of the innate immune response to the infecting pathogen. 9 Activation of the vascular endothelium, platelets, and leukocytes results in dysregulated thrombin generation that occurs both systemically and locally in the lungs of patients with severe pneumonia, resulting in the deposition of fibrin with subsequent tissue damage and microangiopathic pathology. There is evolving evidence that a combination of activation events initiated by exposure of the endothelium, platelets, and leukocytes to pathogen-and damage-associated molecular patterns are the primary instigators of this pathophysiology. 10 The effects of dysregulated thrombin generation are further exacerbated by an inhibition of fibrinolysis and the impairment of natural anticoagulant mechanisms. To date, treatment of DIC has been focused on strategies to target the primary associated pathology 11 ; this, of course, is limited in the case of 2019-nCoV infection, until more is learnt about effective antiviral agents for this new pathogen. Otherwise, supportive care to maintain critical organ function is required. Trials of natural anticoagulant infusions have met with variable outcomes, 12 although recent experience with a soluble thrombomodulin product appears promising. 13 As the 2019-nCoV epidemic progresses, we will learn more about the propensity of this agent to engage both innate immune and hemostatic systems, two critical emergency response pathways that maintain homeostasis under controlled circumstances, but that produce severe pathologies of their own when present under dysregulated conditions. The observations of Tang and colleagues provide early evidence that enhanced vigilance is required to identify the emergence of DIC in 2019-nCoV pneumonia patients. The author declares that they have no conflicts of interest. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster A new coronavirus associated with human respiratory disease in China Clinical features of patients infected with 2019 novel coronavirus in Wuhan The severe acute respiratory syndrome Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients Disseminated intravascular coagulation PAMPs and DAMPs as triggers for DIC How I treat disseminated intravascular coagulation Antithrombin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation: an observational nationwide study Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta-analysis