Evidence suggests that dengue infection may lead to coagulation abnormalities such as prolonged activated partial thromboplastin time (APTT) and prothrombin time (PT), and even prominent hemorrhagic manifestations with thrombocytopenia. In this systematic review and meta-analysis, Adane et al. determined the magnitude of coagulation abnormalities in patients with dengue globally.

Forty-two studies (N=12,221 patients) conducted across Asia (seven countries), South America (one country), and Africa (one country) were included in the analysis. Twenty-two, 15 and 26 studies were used to analyze the magnitude of prolonged APTT and PT, and thrombocytopenia, respectively.

Prolonged APTT was 43%, prolonged PT was 16% and thrombocytopenia was 70%. Sensitivity analysis indicated the presence of high statistical heterogeneity in the results (I2 >97% for all magnitudes). Presence of prolonged APTT, prolonged PT and thrombocytopenia varied among countries with the highest observed in India. Prolonged APTT magnitudes were higher than PT magnitudes across all subpopulations (children, adults, all ages, and age not specified).

Heterogeneity remained significantly high for prolonged APTT and PT across all subpopulations. These results indicate that coagulation abnormalities remain high in patients with dengue. The causes of the high heterogeneity associated with prolonged APTT, prolonged PT and thrombocytopenia remain to be elucidated.

https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009666

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