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DOI: 10.1055/s-0040-1710018
COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure
Publication History
02 April 2020
04 April 2020
Publication Date:
21 April 2020 (online)
Abstract
In late December 2019 an outbreak of a novel coronavirus (SARS-CoV-2) causing severe pneumonia (COVID-19) was reported in Wuhan, Hubei Province, China. A common finding in most COVID-19 patients is high D-dimer levels which are associated with a worse prognosis. We aimed to evaluate coagulation abnormalities via traditional tests and whole blood thromboelastometry profiles in a group of 22 (mean age 67 ± 8 years, M:F 20:2) consecutive patients admitted to the Intensive Care Unit of Padova University Hospital for acute respiratory failure due to COVID-19. Cases showed significantly higher fibrinogen and D-dimer plasma levels versus healthy controls (p < 0.0001 in both comparisons). Interestingly enough, markedly hypercoagulable thromboelastometry profiles were observed in COVID-19 patients, as reflected by shorter Clot Formation Time (CFT) in INTEM (p = 0.0002) and EXTEM (p = 0.01) and higher Maximum Clot Firmness (MCF) in INTEM, EXTEM and FIBTEM (p < 0.001 in all comparisons). In conclusion, COVID-19 patients with acute respiratory failure present a severe hypercoagulability rather than consumptive coagulopathy. Fibrin formation and polymerization may predispose to thrombosis and correlate with a worse outcome.
Authors' Contributions
L.S. and A.B. study design, data analysis, and drafting; A.B., F.P., L.C., and I.T. patient enrolment; L.S. and E.C. performed laboratory tests; P.N. and P.S. study supervision and final approval.
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References
- 1 Singh SK. Middle East respiratory syndrome virus pathogenesis. Semin Respir Crit Care Med 2016; 37 (04) 572-577
- 2 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (04) 844-847
- 3 Spiezia L, Radu C, Marchioro P. , et al. Peculiar whole blood rotation thromboelastometry (Rotem) profile in 40 sideropenic anaemia patients. Thromb Haemost 2008; 100 (06) 1106-1110
- 4 Sørensen B, Johansen P, Christiansen K, Woelke M, Ingerslev J. Whole blood coagulation thrombelastographic profiles employing minimal tissue factor activation. J Thromb Haemost 2003; 1 (03) 551-558
- 5 Chen S, Huang B, Luo DJ. , et al. Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases [in Chinese]. Zhonghua Bing Li Xue Za Zhi 2020; 49 (00) E005
- 6 Zhou F, Yu T, Du R. , et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; pii : S0140–6736(20)30566–3
- 7 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (05) 1094-1099