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Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis.
J Thromb Haemost. 2020 07; 18(7):1738-1742.JT

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 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.

Authors+Show Affiliations

Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy.Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy.Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy.Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.Fondazione IRCCS Ca' Granda Ospedale Maggiore, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milano, Italy.Fondazione IRCCS Ca' Granda Ospedale Maggiore, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milano, Italy.Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy. Fondazione IRCCS Ca' Granda Ospedale Maggiore, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milano, Italy.Fondazione IRCCS Ca' Granda Ospedale Maggiore, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milano, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32302438

Citation

Panigada, Mauro, et al. "Hypercoagulability of COVID-19 Patients in Intensive Care Unit: a Report of Thromboelastography Findings and Other Parameters of Hemostasis." Journal of Thrombosis and Haemostasis : JTH, vol. 18, no. 7, 2020, pp. 1738-1742.
Panigada M, Bottino N, Tagliabue P, et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020;18(7):1738-1742.
Panigada, M., Bottino, N., Tagliabue, P., Grasselli, G., Novembrino, C., Chantarangkul, V., Pesenti, A., Peyvandi, F., & Tripodi, A. (2020). Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. Journal of Thrombosis and Haemostasis : JTH, 18(7), 1738-1742. https://doi.org/10.1111/jth.14850
Panigada M, et al. Hypercoagulability of COVID-19 Patients in Intensive Care Unit: a Report of Thromboelastography Findings and Other Parameters of Hemostasis. J Thromb Haemost. 2020;18(7):1738-1742. PubMed PMID: 32302438.
* Article titles in AMA citation format should be in sentence-case
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,Flora, AU - Tripodi,Armando, Y1 - 2020/06/24/ PY - 2020/04/08/received PY - 2020/04/12/accepted PY - 2020/4/18/pubmed PY - 2020/7/16/medline PY - 2020/4/18/entrez KW - factor VIII KW - hypercoagulability KW - protein C KW - protein S KW - sepsis KW - von Willebrand factor SP - 1738 EP - 1742 JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost VL - 18 IS - 7 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 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. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/32302438/Hypercoagulability_of_COVID_19_patients_in_intensive_care_unit:_A_report_of_thromboelastography_findings_and_other_parameters_of_hemostasis_ L2 - https://doi.org/10.1111/jth.14850 DB - PRIME DP - Unbound Medicine ER -