TY - JOUR
T1 - Hypercoagulability of COVID-19 patients in Intensive Care Unit. A Report of Thromboelastography Findings and other Parameters of Hemostasis
AU - Panigada, Mauro
AU - Bottino, Nicola
AU - Tagliabue, Paola
AU - Grasselli, Giacomo
AU - Novembrino, Cristina
AU - Chantarangkul, Veena
AU - Pesenti, Antonio
AU - Peyvandi, Fora
AU - Tripodi, Armando
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - factor VIII
KW - Hypercoagulability
KW - protein C
KW - protein S
KW - sepsis
KW - von Willebrand factor
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U2 - 10.1111/jth.14850
DO - 10.1111/jth.14850
M3 - Article
C2 - 32302438
AN - SCOPUS:85083865882
VL - 18
SP - 1738
EP - 1742
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
SN - 1538-7933
IS - 7
ER -