Hypercoagulability of COVID‐19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis

Background The severe inflammatory state secondary to COVID‐19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation...

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Veröffentlicht in:Journal of thrombosis and haemostasis Jg. 18; H. 7; S. 1738 - 1742
Hauptverfasser: Panigada, Mauro, Bottino, Nicola, Tagliabue, Paola, Grasselli, Giacomo, Novembrino, Cristina, Chantarangkul, Veena, Pesenti, Antonio, Peyvandi, Flora, Tripodi, Armando
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Limited 01.07.2020
International Society on Thrombosis and Haemostasis. Published by Elsevier Inc
Schlagworte:
Adult
Aged
Anticoagulants
Antithrombin
Betacoronavirus - pathogenicity
Biomarkers - blood
Blood Coagulation
Brief Report
Case-Control Studies
Clinical trials
Coagulation factors
Coronavirus Infections - blood
Coronavirus Infections - diagnosis
Coronavirus Infections - virology
COVID-19
Degradation products
Disseminated intravascular coagulation
factor VIII
Fibrin
Fibrinogen
Hemostasis
Host-Pathogen Interactions
Humans
hypercoagulability
Inflammation
Inflammation Mediators - blood
Intensive care
Intensive Care Units
Middle Aged
Pandemics
Patients
Platelets
Pneumonia, Viral - blood
Pneumonia, Viral - diagnosis
Pneumonia, Viral - virology
Predictive Value of Tests
Prophylaxis
Protein C
protein S
Prothrombin
SARS-CoV-2
Sepsis
Thrombelastography
Thromboembolism
Thrombophilia - blood
Thrombophilia - diagnosis
Thrombophilia - virology
Thromboplastin
Von Willebrand factor
Young Adult
protein C
protein S
hypercoagulability
factor VIII
von Willebrand factor
sepsis
ISSN:1538-7933, 1538-7836, 1538-7836
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Zusammenfassung:Background The severe inflammatory state secondary to COVID‐19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D‐dimer, as well as low fibrinogen. Aims Whole blood from 24 patients admitted at the intensive care unit because of COVID‐19 was collected and evaluated with thromboelastography by the TEG point‐of‐care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis. Results TEG parameters are consistent with a state of hypercoagulability as shown by decreased values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal). Fibrinogen was increased and D‐dimer was dramatically increased. C‐reactive protein was increased. Factor VIII and von Willebrand factor (n = 11) were increased. Antithrombin (n = 11) was marginally decreased and protein C (n = 11) was increased. Conclusion The results of this cohort of patients with COVID‐19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/treatment. Clinical trials are urgently needed to establish the type of drug, dosage, and optimal duration of prophylaxis.
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ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.14850