Case Report: Thrombotic and haemorrhagic disseminated intravascular coagulation in COVID-19.
- 1Department of Critical Care Medicine, The 908th Hospital of Joint Logistic Support Force, Nanchang, China.
- 2Nanchang Key Laboratory of Thrombosis and Haemostasis, Nanchang, China.
Abstract
Background
COVID-19-associated coagulopathy has been predominantly characterised as a hypercoagulable state with fibrinolytic shutdown. However, the full phenotypic spectrum of disseminated intravascular coagulation (DIC) in COVID-19 remains incompletely characterised. This report adds two cases demonstrating that COVID-19-associated DIC can manifest as two distinct phenotypes at opposite ends of the coagulation spectrum.Case summary
We report two cases of severe COVID-19 with diametrically opposed DIC phenotypes. Case 1: a 23-year-old immunosuppressed male with SARS-CoV-2 bloodstream and central nervous system infection developed haemorrhagic DIC, characterised by severe hypofibrinogenemia (0.76 g/L), markedly elevated PIC (>40 μg/mL), and preserved platelet counts (>100 × 10⁹/L). He was successfully treated with titrated tranexamic acid. Case 2: a 54-year-old previously healthy female with severe COVID-19 pneumonia developed thrombotic DIC, characterised by significant thrombocytopenia (platelets 65 × 10⁹/L, nadir 40 × 10⁹/L), multi-organ injury, and lower extremity venous thrombosis. She was successfully treated with low-molecular-weight heparin.Conclusion
COVID-19-associated DIC spans two phenotypes-thrombotic (platelet consumption, requiring anticoagulation) and haemorrhagic (fibrinogen consumption with hyperfibrinolysis, requiring antifibrinolytics)-validating the 2025 ISTH classification and highlighting the need for phenotype-specific therapy guided by serial coagulation monitoring.
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BibTeX
@article{song2026case,
title = {{Case Report: Thrombotic and haemorrhagic disseminated intravascular coagulation in COVID-19.}},
author = {Jingchun Song and Junjie Zeng and Xiaomin Song},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1999533},
url = {https://europepmc.org/article/MED/42922967},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Thrombotic and haemorrhagic disseminated intravascular coagulation in COVID-19.
AU - Jingchun Song
AU - Junjie Zeng
AU - Xiaomin Song
PY - 2026
DA - 2026/10/08
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1999533
UR - https://europepmc.org/article/MED/42922967
AB - Background COVID-19-associated coagulopathy has been predominantly characterised as a hypercoagulable state with fibrinolytic shutdown. However, the full phenotypic spectrum of disseminated intravascular coagulation (DIC) in COVID-19 remains incompletely characterised. This report adds two cases demonstrating that COVID-19-associated DIC can manifest as two distinct phenotypes at opposite ends of the coagulation spectrum.Case summary We report two cases of severe COVID-19 with diametrically opposed DIC phenotypes. Case 1: a 23-year-old immunosuppressed male with SARS-CoV-2 bloodstream and central nervous system infection developed haemorrhagic DIC, characterised by severe hypofibrinogenemia (0.76 g/L), markedly elevated PIC (>40 μg/mL), and preserved platelet counts (>100 × 10⁹/L). He was successfully treated with titrated tranexamic acid. Case 2: a 54-year-old previously healthy female with severe COVID-19 pneumonia developed thrombotic DIC, characterised by significant thrombocytopenia (platelets 65 × 10⁹/L, nadir 40 × 10⁹/L), multi-organ injury, and lower extremity venous thrombosis. She was successfully treated with low-molecular-weight heparin.Conclusion COVID-19-associated DIC spans two phenotypes-thrombotic (platelet consumption, requiring anticoagulation) and haemorrhagic (fibrinogen consumption with hyperfibrinolysis, requiring antifibrinolytics)-validating the 2025 ISTH classification and highlighting the need for phenotype-specific therapy guided by serial coagulation monitoring.
SN - 2296-858X
ER -