The procoagulant pattern of patients with COVID‐19 acute respiratory distress syndrome

Background Few observations exist with respect to the pro‐coagulant profile of patients with COVID‐19 acute respiratory distress syndrome (ARDS). Reports of thromboembolic complications are scarce but suggestive for a clinical relevance of the problem. Objectives Prospective observational study aime...

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Vydáno v:Journal of thrombosis and haemostasis Ročník 18; číslo 7; s. 1747 - 1751
Hlavní autoři: Ranucci, Marco, Ballotta, Andrea, Di Dedda, Umberto, Bayshnikova, Ekaterina, Dei Poli, Marco, Resta, Marco, Falco, Mara, Albano, Giovanni, Menicanti, Lorenzo
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Elsevier Limited 01.07.2020
International Society on Thrombosis and Haemostasis. Published by Elsevier Inc
Témata:
acute respiratory distress syndrome
Aged
Anticoagulants
Anticoagulants - administration & dosage
Antithrombin
Betacoronavirus - pathogenicity
Biomarkers - blood
Blood Coagulation - drug effects
Blood Coagulation Disorders - blood
Blood Coagulation Disorders - diagnosis
Blood Coagulation Disorders - drug therapy
Blood Coagulation Disorders - virology
Blood Coagulation Tests
Brief Report
Clopidogrel
Coagulation
coagulation parameter
Coronavirus Infections - blood
Coronavirus Infections - diagnosis
Coronavirus Infections - drug therapy
Coronavirus Infections - virology
COVID-19
COVID-19 Drug Treatment
D‐dimer
Embolism
Female
Fibrinogen
Fibrinolytic Agents - administration & dosage
Heparin
Host-Pathogen Interactions
Humans
Male
Middle Aged
Molecular weight
Pandemics
Patients
Pneumonia, Viral - blood
Pneumonia, Viral - diagnosis
Pneumonia, Viral - drug therapy
Pneumonia, Viral - virology
Prophylaxis
Prospective Studies
Respiration
Respiratory distress syndrome
SARS-CoV-2
Thromboembolism
Treatment Outcome
viscoelastic tests
Viscoelasticity
COVID-19
D-dimer
acute respiratory distress syndrome
viscoelastic tests
coagulation parameter
ISSN:1538-7933, 1538-7836, 1538-7836
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Shrnutí:Background Few observations exist with respect to the pro‐coagulant profile of patients with COVID‐19 acute respiratory distress syndrome (ARDS). Reports of thromboembolic complications are scarce but suggestive for a clinical relevance of the problem. Objectives Prospective observational study aimed to characterize the coagulation profile of COVID‐19 ARDS patients with standard and viscoelastic coagulation tests and to evaluate their changes after establishment of an aggressive thromboprophylaxis. Methods Sixteen patients with COVID‐19 ARDS received a complete coagulation profile at the admission in the intensive care unit. Ten patients were followed in the subsequent 7 days, after increasing the dose of low molecular weight heparin, antithrombin levels correction, and clopidogrel in selected cases. Results At baseline, the patients showed a pro‐coagulant profile characterized by an increased clot strength (CS, median 55 hPa, 95% interquartile range 35‐63), platelet contribution to CS (PCS, 43 hPa; interquartile range 24‐45), fibrinogen contribution to CS (FCS, 12 hPa; interquartile range 6‐13.5) elevated D‐dimer levels (5.5 μg/mL, interquartile range 2.5‐6.5), and hyperfibrinogenemia (794 mg/dL, interquartile range 583‐933). Fibrinogen levels were associated (R2 = .506, P = .003) with interleukin‐6 values. After increasing the thromboprophylaxis, there was a significant (P = .001) time‐related decrease of fibrinogen levels, D‐dimers (P = .017), CS (P = .013), PCS (P = .035), and FCS (P = .038). Conclusion The pro‐coagulant pattern of these patients may justify the clinical reports of thromboembolic complications (pulmonary embolism) during the course of the disease. Further studies are needed to assess the best prophylaxis and treatment of this condition.
Bibliografie:Funding information
This study was funded by the IRCCS Policlinico San Donato, a Clinical Research Hospital recognized and partially funded by the Italian Ministry of Health.
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ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.14854