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Previous Volume 349:708-709 August 14, 2003 Number 7 Next

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To the Editor: Lee et al. (May 15 issue)¹ describe the clinical and laboratory features of 138 cases of suspected severe acute respiratory syndrome (SARS) in Hong Kong. It is striking that 44.8 percent of the patients had thrombocytopenia, 45.0 percent had elevated levels of D-dimers, and 42.8 percent had a prolonged activated partial-thromboplastin time. This combination suggests the presence of a form of disseminated intravascular coagulation² or pulmonary-induced coagulation and fibrin polymerization with consumption of platelets and clotting factors. Elevated D-dimer levels have also been reported in patients with acute lung injury and in patients with the acute respiratory distress syndrome.³ We suggest that patients with SARS who have elevated D-dimer levels might need anticoagulant therapy or fibrinolytic therapy such as plasminogen activators,⁴ activated protein C, soluble thrombomodulin, antithrombin, tissue factor–pathway inhibitor, activated factor VII–pathway inhibitor, heparin, or low-molecular-weight heparin⁵ in order to reverse intraalveolar coagulation, microthrombi formation, and alveolar and interstitial fibrin deposition.⁶ Such reversals might improve survival.⁵

Ya Ping Wu, Ph.D.
University Medical Center
3584 CX Utrecht, the Netherlands
ywu{at}azu.nl

Ran Wei, M.D.
Taishan Medical College
Taian, Shandong 271000, China

Philip G. de Groot, Ph.D.
University Medical Center
3584 CX Utrecht, the Netherlands

References

1. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1986-1994. [Free Full Text]
2. Taylor FB Jr, Toh C-H, Hoots WK, Wada H, Levi M. Towards a definition, clinical and laboratory criteria, and a scoring system for DIC. Official communications of the Scientific and Standardization Committees and the International Society on Thrombosis and Haemostasis. Chapel Hill: University of North Carolina at Chapel Hill School of Medicine, 2003.
3. Wenzel C, Kofler J, Locker GJ, et al. Endothelial cell activation and blood coagulation in critically ill patients with lung injury. Wien Klin Wochenschr 2002;114:853-858. [Medline]
4. Hardaway RM, Harke H, Tyroch AH, Williams CH, Vazquez Y, Krause GF. Treatment of severe acute respiratory distress syndrome: a final report on a phase I study. Am Surg 2001;67:377-382. [Medline]
5. Laterre PF, Wittebole X, Dhainaut JF. Anticoagulant therapy in acute lung injury. Crit Care Med 2003;31:Suppl:S329-S336. [CrossRef][ISI][Medline]
6. Gunther A, Ruppert C, Schmidt R, et al. Surfactant alteration and replacement in acute respiratory distress syndrome. Respir Res 2001;2:353-364. [CrossRef][ISI][Medline]

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