Nahla A. Alshaikh
COVID-19 associated coagulopathy: A bibliometric investigation
COVID-19,Coagulopathy,Anticoagulants,Co-authorship,Co-citations and,Bibliographic coupling,VOSviewer software
Infection with SARS-CoV-2 initiates an immune-hemostatic response. While both systems are intimately connected and necessary for an efficient immune response to contain the infection, excessive coagulation activation might exceed the valuable benefits by causing thrombotic consequences and excessive inflammation. This biological response is new to clinicians and researchers, and accordingly, tremendous studies have been conducted on coagulopathy and its relationship to COVID-19 disease during this pandemic. Therefore, it takes a research insight from a bibliometric perspective to determine research hotspots and trends of COVID-19 associated coagulopathy (C19-CA). The analysis relies on the Scopus database for bibliographic content and Visualization of Similarities viewer software to map bibliometric data of C19-CA. Our study finds the most eminent authors, journals, institutions, funding organizations, and countries that publish in the C19-CA. Additionally; this research employs bibliometric analysis of co-authorship, co-citations, bibliographic coupling, and co-occurrence of keywords. A total of 2242 studies were retrieved, and the number of annual publications of C19-CA showed remarkable growth. The top-publishing authors on C19-CA are Smadja, D.M., Diehl, J.L., and Gendron, N (France). The total number of articles published in English in these three years was 1241, with the original article accounting for 99.8% and conference papers accounting for 0.2%. Huazhong University of Science and Technology (China) is the top-productive institution, with the US being the top-publishing country. Journal of Thrombosis and Thrombolysis received the highest number of original articles. The research results were mainly published in the fields of Medicine, Biochemistry, Genetics, and Molecular Biology, Immunology and Microbiology. Yuanyuan Li, who is (China), is the top-collaborating author. China and its authors have the highest number of citations. Keywords' co-occurrence analyses of the authors and all keywords revealed the following themes in C19-CA; abnormal coagulation parameters, pulmonary coagulopathy, venous and arterial thrombotic disorders, distinct features of coagulopathy, inflammation, and thrombosis in COVID-19, and anticoagulants and thrombolytic therapies. By combining bibliometric analysis with VOSviewer software, we identified C19-CA's leaders, collaborating institutions, and research hotspots, as well as give references for future research paths.
COVID-19 associated coagulopathy: A bibliometric investigation

Infection with SARS-CoV-2 initiates an immune-hemostatic response. While both systems are intimately connected and necessary for an efficient immune response to contain the infection, excessive coagulation activation might exceed the valuable benefits by causing thrombotic consequences and excessive inflammation. This biological response is new to clinicians and researchers, and accordingly, tremendous studies have been conducted on coagulopathy and its relationship to COVID-19 disease during this pandemic. Therefore, it takes a research insight from a bibliometric perspective to determine research hotspots and trends of COVID-19 associated coagulopathy (C19-CA). The analysis relies on the Scopus database for bibliographic content and Visualization of Similarities viewer software to map bibliometric data of C19-CA. Our study finds the most eminent authors, journals, institutions, funding organizations, and countries that publish in the C19-CA. Additionally; this research employs bibliometric analysis of co-authorship, co-citations, bibliographic coupling, and co-occurrence of keywords. A total of 2242 studies were retrieved, and the number of annual publications of C19-CA showed remarkable growth. The top-publishing authors on C19-CA are Smadja, D.M., Diehl, J.L., and Gendron, N (France). The total number of articles published in English in these three years was 1241, with the original article accounting for 99.8% and conference papers accounting for 0.2%. Huazhong University of Science and Technology (China) is the top-productive institution, with the US being the top-publishing country. Journal of Thrombosis and Thrombolysis received the highest number of original articles. The research results were mainly published in the fields of Medicine, Biochemistry, Genetics, and Molecular Biology, Immunology and Microbiology. Yuanyuan Li, who is (China), is the top-collaborating author. China and its authors have the highest number of citations. Keywords' co-occurrence analyses of the authors and all keywords revealed the following themes in C19-CA; abnormal coagulation parameters, pulmonary coagulopathy, venous and arterial thrombotic disorders, distinct features of coagulopathy, inflammation, and thrombosis in COVID-19, and anticoagulants and thrombolytic therapies. By combining bibliometric analysis with VOSviewer software, we identified C19-CA's leaders, collaborating institutions, and research hotspots, as well as give references for future research paths.

With its persistent global march and severe morbidity and death, the coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the world. SARS coronavirus 2 (SARS-CoV-2) is a coronavirus that causes human illness and is recognized as COVID-19 by the World Health Organization [1,2]. Bats and birds are the most common coronavirus hosts, with zoonotic transmission and a long history of animal-to-animal-to-human transmission. A new form of coronavirus epidemic was discovered in December 2019 with a novel member of the coronavirus genus [3,4]. Given the remarkable similarity of COVID-19 to other SARS-like viruses discovered in bats, the viral reservoir might be bats. COVID-19, initially diagnosed in December 2019 in Wuhan, China, has become a worldwide pandemic with widespread sickness and death and a devastating effect on society, culture, and the global economy [5,6]. The disease first appeared in Wuhan, China, in December 2019 and quickly spread across the globe, infected 48,539,872 people, and caused 1,232,791 deaths in 215 countries, and the infection is still spreading at the time of manuscript preparation [7]. Severe COVID-19 is related to elevated pro-inflammatory cytokines, including TNF and interleukins like IL-1 and IL-6. IL-6 may activate coagulation and generate thrombin in mononuclear cells [8,9]. TNF- and IL-1 are the primary mediators of endogenous anticoagulant system inhibition [10]. A cytokine storm profile is identified in COVID-19 patients with elevated pro-inflammatory cytokines and chemokines levels [8]. Although respiratory compromise is the primary symptom of COVID-19, preliminary research suggests that higher circulating D-dimer levels are related to death, indicating a separate coagulation issue associated with COVID-19 [11,12]. Recent postmortem examinations of COVID-19 patients show the presence of fibrin thrombi inside dilated small arteries and capillaries, as well as significant extracellular fibrin deposition [13,14]. Given the worldwide pandemic, there is an urgent need to study the incidence of bleeding and thrombotic symptoms associated with C19-CA and the therapeutic value of abnormal coagulation tests to predict risk for bleeding thrombosis and disease severity. A prolonged prothrombin time, in addition to D-dimer, has been linked to lower survival and an increased requirement for critical care [15,16]. A summary for the mechanism of thrombosis caused by SARS-COV-2 is shown in Scheme 1 based on previous studies [[8], [9], [10], [11], [12], [13], [14], [15], [16]]. This study collects research data of C19-CA in the Scopus Database and uses VOSviewer to perform co-citation analysis on authors, countries and institutions, journals and cited journals, authors and cited reference, and keywords, and combined with co-citation frequency, total link strength, and related reference to explore new knowledge, research hotspots, and trends of C19-CA, which will provide a reference for in-depth exploration of this field.

Scopus is an indexing and abstracting database that includes full-text links to 14,000 journal articles from 4000 publishers, as well as the references contained within those articles [17]. It is provided by Elsevier, which enables a researcher to search the database comprising previous as well as present articles [18]. From 2020 to 22 February 2022, we utilized “covid* AND coagulation” as the topic phrase, abstract, or title to extract relevant research data from the Scopus Database. In the query, the asterisk serves as a truncation symbol to accommodate variations of the queried term (e.g., covid, covid19, covid-19). The total number of research documents on C19-CA obtained from the Scopus database was 2242 (Table 1), which covered all sorts of publications (article, review, letter, note, editorial, book chapter, short survey, erratum, conference paper, book, and data paper) in a variety of languages. Original publications and conference papers published in English were the only sources of information as shown in Fig. 1. The results were saved in a CSV file. Citation, bibliographical, abstract, and keyword data, as well as funding information, were extracted. At the same time, we gathered data on the number of yearly publications, research genres, and the number of journal articles.

The number of yearly publications, study kinds, and journal articles was imported into Excel 2013. The number of yearly publications was estimated in Graphpad Prism 7 Software (San Diego, CA). The research kinds were categorized and descriptively assessed, and the top 10 journals with the most articles were screened, as well as their impact factor (IF) of 2020.

Virtual bibliometric networks are networks of literature and can be built using Visualization of Similarities viewer (VOSviewer) software. These networks may be built via citations, bibliographic coupling, co-citations, or co-authorship relationships. VOSviewer also has text mining capabilities to build and display co-occurrence networks of key phrases from the scientific literature. VOSviewer, from the University of Leiden's Centre for Science and Technology Studies, works with Web of Science, Scopus, PubMed, RIS, and Crossref JSON files. Research hotspots and trends have been studied extensively using VOSviewer. Co-citation analysis is the technique of mining a document's co-citation connection [19,20]. The examination of the evolutionary potential dynamic process of associated research areas and the discovery of boundaries in field development is considered to be possible by mining the “co-citation relationship”. Co-citation analysis quantifies complicated and varied information, revealing the underlying significance of internal correlation and complex information features. Pure quantitative analysis, which may not be able to portray the underlying context of discipline growth fully, is indisputable since it heavily relies on statistics. However, quantitative analysis has a clear advantage: it can clearly depict a field's overall growth trend, network structure, and research hotspots [21]. By quantifying linkages between high-yield authors, nations and institutions, journals, and keywords, VOSviewer may uncover new innovations and trends in numerous sectors. A keyword clustering analysis was also performed in this study in order to differentiate between the cognitive domains [22] related to C19-CA.

This study summarizes C19-CA publications and citations by year, the most productive and influential C19-CA authors, the most productive and influential universities contributing to C19-CA, and the most productive and influential countries contributing to C19-CA. Additionally, we investigate author co-citations, co-authorships, and the bibliographic association of writers, institutions, and nations. Our investigation aims to ascertain who, among authors, institutions, and countries, develops and exerts influence over C19-CA knowledge. We did it using bibliographic data from the Scopus database. We use a combination of descriptive and graphical analytics on original articles and conference papers.

The yearly publications of C19-CA are shown in Fig. 2. The number of yearly publications increased dramatically from 2020 to 2021. Before 2020, there was no publication on C19-CA. The first two publications [23,24] were published from India and Italy, and they have aided in the fast growth of C19-CA investigations after 2020. This mirrored the coagulation studies' remarkable rise during the last three years. This may be because the disease has spread extensively in Italy, considered one of the first countries to be affected by the pandemic. The total number of articles published in English in these three years was 1241, with the original article accounting for 99.8% and conference papers accounting for 0.2%. This implies that the majority of the data originates from original research. Other types of documents extracted from the Scopus were not used. Review articles summarize the available literature on a subject in an effort to convey the current level of knowledge about the subject. Therefore, it is not recommended to be used in bibliometrics [25]. With a total of 735 articles published in 2021, the number of yearly publications hit a new high (Fig. 2). As shown in Fig. 3, most of the articles were originated from the field of Medicine (60.8%), followed by Biochemistry, Genetics, and Molecular Biology (13.8%), Immunology and Microbiology (7.0%), and Pharmacology, Toxicology, and Pharmaceutics (3.4%). The top-publishing authors (Fig. 4) are Smadja, D.M. (European Hospital Georges Pompidou, France), Diehl, J.L., and Gendron, N (University of Paris, Paris, France). These three authors are the members of French Multicenter Cohort Study. They have done some research on curative anticoagulation's role in preventing endothelial lesion in COVID-19, angiopoietin-2 as a marker and good predictor, troponin and D-Dimer, pulmonary embolism, and anticoagulation treatments [[26], [27], [28], [29], [30], [31], [32], [33]]. Huazhong University of Science and Technology, (59), Tongji Medical College (56) China, and Harvard Medical School (33), USA, are the top-productive institutions. The Chinese research was on coagulopathy, anticoagulant treatment, D-dimer surge, early coagulation tests as a predictor of COVID-19, laboratory abnormalities, anti-phospholipid antibody, and effect of combination antiviral therapy on hematological profiles of COVID-19 patients [[34], [35], [36], [37], [38], [39], [40], [41]]. United States, China, and Italy are the top-publishing countries (Fig. 5). 35% of the total research has shown funding resources, and top-funding agencies are the National Natural Science Foundation of China and the National Institutes of Health (USA). This extra study funding was required due to the fact that China is the origin of the illness and health care is demanding. As for the United States, this may be a result of the strength of public opinion and the severity with which it combats diseases. These nations also possess large economic resources and biosafety labs of Class III. The rapid contact with the patients and the prompt approval from the study ethics committees expedited the receipt of this funding. The current report revealed that 160 journals were used as a platform to disseminate original articles. The top-publishing journals are shown in Table 2, along with their impact factors. Four journals from these top ten are from the field of thrombosis, this includes Thrombosis and Haemostasis, Thrombosis Research, Journal of Thrombosis and Thrombolysis, and Journal of Thrombosis and Haemostasis.

International cooperation allows researchers to obtain access to extra, often specialized knowledge, acquire fresh views on research, and form ties with others in the field, all of which may be beneficial to new fields of research. Participants collaborated for a variety of reasons, including creating connections, gaining access to knowledge, access to highly sophisticate scientific equipment, and advancing their careers. Bilateral and multilateral interactions, as well as collaborations inside and across fields, are all examples of international cooperation [42]. While co-authorship in research articles was uncommon before the 1980s, it has progressively increased since then, according to the bibliographic record. There's evidence that individual articles have numerous authors and that the writers of each paper are from different nations. Because authorship has grown exponentially but the number of joint publications has only climbed linearly, it is suggested that connection is deepening. Changing cooperation patterns in Europe are believed to be a result of the European Commission's Framework Programmes' cohesion elements, which promote multi-national collaborations regardless of scientific quality [43]. VOSviewer was used in this study to visualize the co-authorship between authors. 8326 authors meet the thresholds of the minimum number of documents of one author. Fig. 6 showed the visualization map of co-authorship based on authors. A total of fifty authors with a minimum number of eight documents were categorized in five clusters with 596 links and a total link strength of 881. Cluster one (Red), two (Green), three (Blue), four (Yellow), and five (Purple) consisted of 14, 11, 9, 8, and 8 authors, respectively. It is noticed that all top-collaborating authors are Chinese, and this confirmed that research in C19-CA was initiated in China. This confirmed that the national collaboration is very active in China. This is because the Chinese government has called on all research agencies to work together to fight this pandemic. They have also put together national committees of experts to work together [44]. Yuanyuan Li, who is affiliated to the Department of Laboratory Medicine, Wuhan Hospital of Traditional Chinese Medicine, Hubei, China) is the top-collaborating author with 342 links and a total link strength of 85. International collaboration amongst the research organizations is remarkably weak. Among the 5956 organizations that participated in C19-CA, only three have met the limit of four co-authored articles. Department of Medicine, Mcmaster University, Canada, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China, and Harvard Medical School, Boston, the US, are the most collaborating agencies. United States, United Kingdom, Italy, Germany, Netherlands, Canada, and China are the top collaborating countries with total link strength of 234, 143, 113, 105, 78, 63, and 62, respectively (Fig. 7). The scientific elite required a collaborative mindset and approach to combat this pandemic in order to bring about transformational and systemic change. Regardless of who spends the money, a lot of time and resources should be devoted to this issue. To build relationships, share information, and collaborate effectively, it is essential to identify potential partners and take part in their development. The only method that is capable of shedding light on this cooperation in a manner that can be quantified is that of bibliometric research.

The citation analysis of research articles conducted using VOSviewer helped us find influential documents (n = 1241) in the area of C19-CA, generating a distribution map of cited documents. The number of times an article is cited in scientific publications demonstrates its effect on a subject and its authors and journals [45]. Out of 1241, 914 were cited one time, 758 were cited two times, 377 were cited ten times, 101 were cited 50 times, and 55 were cited hundred times (Fig. 8). The top-cited articles are shown in Table 3. A visualization network was constructed for the articles with more than sixty citations. Only 87 articles were shown to be connected in the map depicted in Fig. 8 with 48 nodes, twelve clusters, and 82 links. The top-cited articles had bigger nodes. All articles were published in 2020, and helped to explode and shape the research on C19-CA. We note that most of them are not far from blood clotting, confirming that they were the cornerstone for C19-CA research. Authors were also mapped using VOSviewer. Of the 9824, 27 meet the threshold of minimum ten citations per documents (Fig. 9). This group of top-cited authors (n = 27) were clustered into six groups. The top-cited author is Chen, X. (China). He has 31 documents, h-index of eight, and 4165 citations. All the top-cited articles belong to leading journals. More enigmatically, these highly prominent academic studies have covered a broad spectrum of C19-CA. Journal of Thrombosis and Haemostasis is the top-cited source in C19-CA with 5592 citations. The Department of Pulmonary and Critical Care Medicine at Zhongshan Hospital, Fudan University (China), received the highest number of citations (n = 3937). China represented a hotspot and bursting point for COVID-19 research. It received 5289 citations for 218 documents with total link strength of 883 and average citation per document of 70.13. United States, Italy, Netherlands, Germany, United Kingdom, and France had citations of more than 2000 times (Table 4). The links and clusters of the top 38 cited countries are shown in Fig. 10. Eight clusters were formed with 368 links and total link strength of 3861. These clusters of cited countries represent the important geographical spots that yielded the most influential research. Nodes with the same color represent one cluster. It is important to note that the majority of publications published in Scimago Journal & Country Rank (SJR) journals originate from the United States, the United Kingdom, and China.

Co-citations and bibliographic coupling are also examined in this research [55]. Using VOSviewer software, the research applies a mapping approach to the bibliographic data. We show patterns of impact in co-citations and bibliographic coupling using this program. When two papers obtain a citation from the same third document, this is known as co-citation. Author co-citation analysis elucidates how domain specialists, such as authors, link ideas across published works. When two studies quote the same third document, this is known as bibliographic coupling. Authors are interested in co-citation analysis, but authors, institutions, and nations are interested in bibliographic coupling [56,57]. The network visualization in Fig. 11 is the outcome of an examination of authors' co-citations in C19-CA. This study used a 200-citation minimum and the 378 most representative connections. Each circle or node represents one author, and the linkages between the nodes reflect the relationship between authors (i.e., through co-citations). The distance between two researchers on the map approximates their co-citation relationship. The bigger the author's name and the wider the circle, the heavier the node; the weight of each node is determined by the combined strength of all the connections that connect to it. Fig. 11 map illustrates three numbered clusters. The first cluster (red) is anchored by authors Li, Wang, Wang, and Hu; this cluster is heterogeneous, with authors working on topics related to clinical features of COVID-19 patients [58]. A second cluster (green) is anchored by authors Thachil, Tang, Sun, and Li; these authors tend to research topics related to thrombosis and hypercoagulability [59]. The third one (blue) is anchored by Zhou, F. Zhou and other authors in the cluster tend to conduct research on infectious diseases and clinical microbiology [44]. Monitoring pairs of publications that are often mentioned in the same source articles is known as co-citation analysis. Clusters of research start to emerge when several researchers co-cite the same pairs of publications. These clusters typically have a common subject among the co-cited works [60]. From this perspective, all of the articles that have served as the foundation of thrombosis and COVID research have been published on the nature and cause of the disease. Bibliographic coupling occurs when two documents cite the same third document. Bibliographic coupling uses citations to explain the similarities between two documents, authors, institutions, or countries. This process assumes that two papers referencing the third paper are highly related and should be concentrated in a cluster solution on the visualization map. The strength of the bibliographic coupling is determined by the total number of references or citations of other third documents that they share [55,56]. Fig. 12 illustrates the bibliographic coupling of authors published in C19-CA. A large cluster (red) of coupled authors is anchored by Zhang, Y., whose research focuses on coagulopathy, anti-phospholipid antibodies, and hemorrhagic patterns of various diseases, including COVID-19. We find Wang, Y., whose research also focuses on molecular virology, in the same cluster. The third cluster is equally anchored by researchers from France, including Planquette, B. (pulmonary embolism), Gendron, N. (direct oral anticoagulants and endothelial dysfunction in hematological diseases), Khider, L. (d-dimer at hospital admission for COVID-19), Smadja, D.M. (innovative therapies in hemostasis), Goudot, G. and Mirault, T. (vascular medicine and biosurgical research). In order to provide a science mapping method that is complementary to the prevalent co-citation cluster analytical method, it was proposed that bibliographic coupling could be combined with a cluster method based on prior findings and theoretical considerations [61].

The co-occurrence of author and all keywords examines both keywords that appear in the same texts and keywords that appear more frequently in publications, typically beneath the introduction. Author keywords are those that the author(s) believe best represent the contents of their paper. Indexed keywords are those that have been picked by content providers and standardized using publicly accessible vocabularies. Unlike Author keywords, indexed keywords take synonyms, other spellings, and plurals into consideration [62]. Using VOSviewer software, the research applies a mapping approach to the bibliographic data of keywords. We show patterns of impact in the co-occurrence of all keywords using this program. Four clusters were observed when analyzing all the keywords for C19-CA. 169 keywords with a minimum occurrence of 50 times were included in Fig. 13. Cluster one (red) was anchored by two keywords (d dimer and c reactive protein). In a pandemic, laboratory biomarkers to predict the severity of COVID-19 are crucial, since resource allocation must be meticulously planned, particularly in the context of respiratory support readiness. There have been proposed laboratory indicators for risk categorization. There is emerging evidence that critically sick individuals exhibit hyperinflammatory features, including high blood C-reactive protein, procalcitonin, D-dimer, and hyperferritinemia. These data imply that a cytokine storm may play a critical role in the pathogenesis of COVID-19 [63,64]. Cluster two (green) was dominant by clinical studies on C19-CA. Multiple potential vaccines against COVID-19 infection were tested in large-scale, randomized, placebo-controlled clinical studies [65]. Studies on blood coagulation, thrombocytopenia, complication, anticoagulant agent, heparin are expressed by keywords from cluster three (blue). The coagulopathy that is caused by COVID-19 is a complicated process that is quite separate from the coagulopathy that is caused by sepsis in the traditional sense. Anticoagulation plays a major role in the treatment of COVID-19, in contrast to the more traditional form of sepsis; nonetheless, there are no practice recommendations that are specific to these patients [66]. Keywords such as virology, blood, metabolism, and disease severity were central to cluster four (yellow). The study also employs a mapping method to the bibliographic data of author's keywords using VOSviewer software (Fig. 14). Using this tool, we reveal patterns of influence in the co-occurrence of the author's keywords. 55 keywords used by authors for their research were categorized into six clusters with 561 links and total link strength of 1193. Cluster one (red) was anchored by keywords reflecting research on acute respiratory distress syndrome, biomarkers for COVID-19, c-reactive protein, and mortality. Cluster two (green) was anchored by the studies related directly to C19-CA such as thrombosis, hemostasis, fibrinolysis, thrombophilia, and heparin. Cluster three (blue) led by keywords such as pulmonary embolism and venous thromboembolism. Cytokine storm and IL-6 are the most occurred keywords in cluster four (yellow). Six keywords gathered together to form cluster 5 (purple). The keyword “inflammation” led the cluster with occurrence, total link strength, and links of 78, 112, and 35, respectively. Cluster six (light blue) is the closet to C19-CA research in terms of pathophysiology and treatments. Mapping the author and index keywords led to the formation of different clusters in the two cases. In the first case, the clusters were only four and overlapped. Nevertheless, the conceptual structure of the author's keywords was more severe. This appears clearly in the green cluster, where it focused most of his attention on the keywords related to thrombosis only. And this, of course, despite the fine conceptual overlap between the clusters.

Infection with SARS-CoV-2 initiates an immune-hemostatic response. While both systems are interdependent and necessary for an effective immune response to contain the infection, excessive coagulation activation can outweigh the beneficial effects by causing excessive inflammation, thrombotic complications, and tissue damage, resulting in acute lung injury, respiratory dysfunction, acute respiratory distress syndrome, disseminated intravascular coagulation, multiple organ failure, and even death. C19-CA is defined by high D-dimer and fibrinogen levels and a prolonged prothrombin time, with a predominance of thrombotic/multiple organ failure with systemic thrombotic consequences in both the venous and arterial vasculatures [40,44,58]. As a result, anticoagulants and/or thrombolytic therapy enable the prevention or reduction of “excessive” thrombin production while maintaining “adaptive” hemostasis [39,59]. This critical life-saving treatment contributes to the reduction of continuing fibrin deposition and microthrombi development in the airway and lung parenchyma, consequently lowering acute respiratory distress syndrome-related mortality. Additionally, it lyses blood clots that have developed in key organs such as the cardiac and cerebral blood vessels. Additionally, anticoagulants and thrombolytic treatments provide extra benefit in the context of COVID-19 because of their anti-inflammatory action. Combining immunomodulatory and anticoagulant methods in COVID-19 patients shows promise but requires more exploration [67]. Research on C19-CA continues to support this exploration from various aspects of this biological phenomenon. To get more insights from three years old research, we have used only original articles and conference papers. Review, book chapter, note, letter, editorial, book, short survey, and data paper were excluded. Conference papers were deficient compared to original articles (99.8%), and this may be because of the social distancing and travel restriction during the COVID-19 pandemic. At the author level, authors from the French Multicenter Cohort Study have published the highest number of articles. This French group worked on anticoagulants and thrombolytic therapies in COVID-19. The top-cited author is Chen (China). Tang is the top-cited author who worked on abnormal coagulation parameters and coagulopathy in COVID-19. Journal of Thrombosis and Thrombolysis was utilized by academicians and clinicians as a dissemination platform to publish 38 original articles until the moment of writing this paper. China represented a hotspot and bursting point for COVID-19 research. It received 5289 citations for 218 documents with total link strength of 883. Although it is related indirectly to coagulation, Wu C. published the top-cited article “Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China” in JAMA Internal Medicine [46]. However, Klok F.A. published on C19-CA “Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Keyword co-occurrence analyses of the authors and all keywords revealed the following themes in C19-CA; abnormal coagulation parameters, pulmonary coagulopathy, venous and arterial thrombotic disorders, distinct features of coagulopathy, inflammation, and thrombosis in COVID-19, and anticoagulants and thrombolytic therapies. Many strengths can be extracted from this current work. This is the first and only study so far that has collected all the research related to the effect of this COVID disease on coagulation. This study used a more than sufficient number of research documents (n = 1241) to be able to extract reliable and diverse data. One of the strengths of this study is that it relied on original research and not review articles. The discipline of bibliometrics comprises a wide range of strategies and techniques, but it is best recognized for its attempts to gauge the significance of scientific research using a number of bibliometric markers. The current findings can be useful to drug makers, public health officials, and infectious disease specialists. Many scientists, clinicians, and researchers deserve support and ethical recognition. The current study proved the role of many of them in curbing this epidemic that swept the world. In sum, our paper provides insights into the evolution of research published in C19-CA over its three-year time. Authors and publications from China, France, and the USA are particularly influential. However, the topic is not becoming more geographically diverse. The mapping of co-citations and bibliographic coupling suggests that several heterogeneous clusters represent work published in C19-CA. To bring about revolutionary and systemic change, the scientific elite needed a collaborative mentality and methodology. No matter who pays, this issue needs a lot of time and money. Identifying and developing potential partners is key to building connections, sharing information, and collaborating effectively. Only bibliometric studies can quantify this interaction. This study has a number of shortcomings. Firstly, relying solely on citations is not a strategy that is encouraged. Due to the fact that the number of citations a piece of work receives is not always an indication of its intellectual importance, some significant works may only receive a few citations, while other articles may receive a number of critical citations. Second, this article relied solely on the database Scopus, which may have caused it to exclude certain essential details that are available in other databases, such as PubMed and WOS. Thirdly, our investigation exclusively used research publications that were written in the English language. Ignoring other languages has the risk of leading one to overlook vital information that is only available in those languages.

Nahla Alshaikh: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.

This work was supported by the Deanship of Scientific Research, 10.13039/100009388Jazan University, Jazan, Saudi Arabia (grant number: W43-064).

The data that has been used is confidential.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.