Clinical and laboratory features of hypercoagulability in COVID-19 and other respiratory viral infections amongst predominantly younger adults with few comorbidities

Abstract

COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and other respiratory viral (non-CoV-2-RV) infections are associated with thrombotic complications. The differences in prothrombotic potential between SARS-CoV-2 and non-CoV-2-RV have not been well characterised. We compared the thrombotic rates between these two groups of patients directly and further delved into their coagulation profiles. In this single-center, retrospective cohort study, all consecutive COVID-19 and non-CoV-2-RV patients admitted between January 15th and April 10th 2020 were included. Coagulation parameters studied were prothrombin time and activated partial thromboplastin time and its associated clot waveform analysis (CWA) parameter, min1, min2 and max2. In the COVID-19 (n = 181) group there were two (1.0 event/1000-hospital-days) myocardial infarction events while one (1.8 event/1000-hospital-day) was reported in the non-CoV-2-RV (n = 165) group. These events occurred in patients who were severely ill. There were no venous thrombotic events. Coagulation parameters did not differ throughout the course of mild COVID-19. However, CWA parameters were significantly higher in severe COVID-19 compared with mild disease, suggesting hypercoagulability (min1: 6.48%/s vs 5.05%/s, P < 0.001; min2: 0.92%/s2 vs 0.74%/s2, P = 0.033). In conclusion, the thrombotic rates were low and did not differ between COVID-19 and non-CoV-2-RV patients. The hypercoagulability in COVID-19 is a highly dynamic process with the highest risk occurring when patients were most severely ill. Such changes in haemostasis could be detected by CWA. In our population, a more individualized thromboprophylaxis approach, considering clinical and laboratory factors, is preferred over universal pharmacological thromboprophylaxis for all hospitalized COVID-19 patients and such personalized approach warrants further research.

Paradox of Predictors in Critically ill COVID-19 Patients: Outcome of a COVID-dedicated Intensive Care Unit

“…Besides following the standard guideline of the treatment protocol, this might be due to racial and demographic variation of population arising further question about the consistency of predictors for COVID-19. A significant difference of increased creatinine and triglyceride was found between the survived and dead patients in our study, whereas ALT, PT, APTT, and INR were non-significant that differs from other studies as a predictor of hypercoagulability 35 . The overall elevation of inflammatory, hepatic (ALT), and cardiac (Troponin-I) biomarkers were reported in studies in the US population28 but were non-significant in our cohort as a predictor of mortality outcome among critically ill COVID-19 patients in ICU.…”

Evaluation of coagulation status using clot waveform analysis in general ward patients with COVID-19

“…In contrast, alterations of fibrin clot structure/function appear to be more associated with VTE [ 9 , 10 ]. Considering that CWA parameters were strongly correlated with plasma fibrinogen levels, which is consistent with a previous report [ 11 ], and that fibrinogen theoretically enhances the speed of clot formation, CWA can provide more precise information regarding alterations in fibrin clot properties, which might represent risk factors for VTE, than fibrinogen assays.…”

Severe Brain Damage in a Moderate Preterm Infant as Complication of Post-COVID-19 Response during Pregnancy

“…Systemic inflammatory responses and coagulation disturbances are known complications of acute SARS-CoV-2 infection in intensive care patients [ 10 , 11 ]. Hyperinflammatory responses also occur with temporal delay of several months after SARS-CoV-2 infection, for example, multisystem inflammatory syndrome in children.…”