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 R and K 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.

Hypercoagulability of COVID-19 patients in Intensive Care Unit: A Report of Thromboelastography Findings and other Parameters of Hemostasis / M. Panigada, N. Bottino, P. Tagliabue, G. Grasselli, C. Novembrino, V. Chantarangkul, A. Pesenti, F. Payvandi, A. Tripodi. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7836. - (2020). [Epub ahead of print] [10.1111/jth.14850]

Hypercoagulability of COVID-19 patients in Intensive Care Unit: A Report of Thromboelastography Findings and other Parameters of Hemostasis

N. Bottino;G. Grasselli;A. Pesenti;F. Payvandi;
2020

Abstract

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 R and K 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.
factor VIII; Hypercoagulability; protein C; protein S; sepsis; von Willebrand factor
Settore MED/41 - Anestesiologia
2020
17-apr-2020
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/738487
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