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Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia.
J Thromb Thrombolysis. 2020 Aug; 50(2):281-286.JT

Abstract

Critically ill patients with COVID-19 pneumonia suffered both high thrombotic and bleeding risk. The effect of SARS-CoV-2 on coagulation and fibrinolysis is not well known. We conducted a retrospective study of critically ill patients admitted to an intensive care unit (ICU) a cause of severe COVID-19 pneumonia and we evaluated coagulation function using rotational thromboelastometry (ROTEM) on day of admission (T0) and 5 (T5) and 10 (T10) days after admission to ICU. Coagulation standard parameters were also evaluated. Forty patients were enrolled into the study. The ICU and the hospital mortality were 10% and 12.5%, respectively. On ICU admission, prothrombin time was slightly reduced and it increased significantly at T10 (T0 = 65.1 ± 9.8 vs T10 = 85.7 ± 1.5, p = 0.002), while activated partial thromboplastin time and fibrinogen values were higher at T0 than T10 (32.2 ± 2.9 vs 27.2 ± 2.1, p = 0.017 and 895.1 ± 110 vs 332.5 ± 50, p = 0.002, respectively); moreover, whole blood thromboelastometry profiles were consistent with hypercoagulability characterized by an acceleration of the propagation phase of blood clot formation [i.e., CFT below the lower limit in INTEM 16/40 patients (40%) and EXTEM 20/40 patients (50%)] and significant higher clot strength [MCF above the upper limit in INTEM 20/40 patients (50%), in EXTEM 28/40 patients (70%) and in FIBTEM 29/40 patients (72.5%)]; however, this hypercoagulable state persists in the first five days, but it decreases ten day after, without returning to normal values. No sign of secondary hyperfibrinolysis or sepsis induced coagulopathy (SIC) were found during the study period. In six patients (15%) a deep vein thrombosis and in 2 patients (5%) a thromboembolic event, were found; 12 patients (30%) had a catheter-related thrombosis. ROTEM analysis confirms that patients with severe COVID-19 pneumonia had a hypercoagulation state that persisted over time.

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Authors+Show Affiliations

Emergency Department and Critical Care Area, Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.

Department of Anesthesia and Intensive Care, Orthopedic Anesthesia, University-Hospital Careggi, Florence, Italy. gianesello.lara@libero.it.

Emergency Department and Critical Care Area, Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.

Emergency Department and Critical Care Area, Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.

Emergency Department and Critical Care Area, Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.

Emergency Department and Critical Care Area, Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.

Pub Type(s)

Journal Article

Observational Study

Language

eng

PubMed ID

32394236

Citation

Pavoni, Vittorio, et al. "Evaluation of Coagulation Function By Rotation Thromboelastometry in Critically Ill Patients With Severe COVID-19 Pneumonia." Journal of Thrombosis and Thrombolysis, vol. 50, no. 2, 2020, pp. 281-286.

Pavoni V, Gianesello L, Pazzi M, et al. Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. J Thromb Thrombolysis. 2020;50(2):281-286.

Pavoni, V., Gianesello, L., Pazzi, M., Stera, C., Meconi, T., & Frigieri, F. C. (2020). Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. Journal of Thrombosis and Thrombolysis, 50(2), 281-286. https://doi.org/10.1007/s11239-020-02130-7

Pavoni V, et al. Evaluation of Coagulation Function By Rotation Thromboelastometry in Critically Ill Patients With Severe COVID-19 Pneumonia. J Thromb Thrombolysis. 2020;50(2):281-286. PubMed PMID: 32394236.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. AU - Pavoni,Vittorio, AU - Gianesello,Lara, AU - Pazzi,Maddalena, AU - Stera,Caterina, AU - Meconi,Tommaso, AU - Frigieri,Francesca Covani, PY - 2020/5/13/pubmed PY - 2020/7/23/medline PY - 2020/5/13/entrez SP - 281 EP - 286 JF - Journal of thrombosis and thrombolysis JO - J Thromb Thrombolysis VL - 50 IS - 2 N2 - Critically ill patients with COVID-19 pneumonia suffered both high thrombotic and bleeding risk. The effect of SARS-CoV-2 on coagulation and fibrinolysis is not well known. We conducted a retrospective study of critically ill patients admitted to an intensive care unit (ICU) a cause of severe COVID-19 pneumonia and we evaluated coagulation function using rotational thromboelastometry (ROTEM) on day of admission (T0) and 5 (T5) and 10 (T10) days after admission to ICU. Coagulation standard parameters were also evaluated. Forty patients were enrolled into the study. The ICU and the hospital mortality were 10% and 12.5%, respectively. On ICU admission, prothrombin time was slightly reduced and it increased significantly at T10 (T0 = 65.1 ± 9.8 vs T10 = 85.7 ± 1.5, p = 0.002), while activated partial thromboplastin time and fibrinogen values were higher at T0 than T10 (32.2 ± 2.9 vs 27.2 ± 2.1, p = 0.017 and 895.1 ± 110 vs 332.5 ± 50, p = 0.002, respectively); moreover, whole blood thromboelastometry profiles were consistent with hypercoagulability characterized by an acceleration of the propagation phase of blood clot formation [i.e., CFT below the lower limit in INTEM 16/40 patients (40%) and EXTEM 20/40 patients (50%)] and significant higher clot strength [MCF above the upper limit in INTEM 20/40 patients (50%), in EXTEM 28/40 patients (70%) and in FIBTEM 29/40 patients (72.5%)]; however, this hypercoagulable state persists in the first five days, but it decreases ten day after, without returning to normal values. No sign of secondary hyperfibrinolysis or sepsis induced coagulopathy (SIC) were found during the study period. In six patients (15%) a deep vein thrombosis and in 2 patients (5%) a thromboembolic event, were found; 12 patients (30%) had a catheter-related thrombosis. ROTEM analysis confirms that patients with severe COVID-19 pneumonia had a hypercoagulation state that persisted over time. SN - 1573-742X UR - https://www.unboundmedicine.com/medline/citation/32394236/Evaluation_of_coagulation_function_by_rotation_thromboelastometry_in_critically_ill_patients_with_severe_COVID_19_pneumonia_ DB - PRIME DP - Unbound Medicine ER -