In Reply — Micro-Thrombosis, Perfusion Defects, and Worsening Oxygenation in COVID-19 Patients: A Word of Caution on the Use of Convalescent Plasma

This letter to the editors of Mayo Clinic Proceedings continues an ongoing scholarly conversation around the article "Safety Update: COVID-19 Convalescent Plasma in 20,000 Hospitalized Patients." The authors respond to a previous letter that raised concerns about the impact of procoagulant factors in plasma on the coagulation cascades of patients with severe COVID-19.

In summary:

  • The authors agree with the word of caution in the previous letter, particularly regarding patients with COVID-19 who have dysregulated coagulation systems that promote hypercoagulation.
  • The coagulation profile of plasma and its likely effect on hemostatic balance should be a factor in clinical decisions about the therapeutic use of convalescent plasma.
  • However, the authors argue that the low rate of thrombotic and thromboembolic events provides strong support of the safety profile of convalescent plasma, even among hospitalized patients with severe COVID-19.