Clotting Factors in COVID-19: Epidemiological Association and Prognostic Values in Different Clinical Presentations in an Italian Cohort

Micco, Pierpaolo Di; Russo, Vincenzo; Carannante, Novella; Imparato, Michele; Rodolfi, Stefano; Cardillo, Giuseppe; Lodigiani, Corrado

doi:10.3390/jcm9051371

Cited by 77 publications

(91 citation statements)

References 15 publications

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“…In addition, the plasma fibrinogen level was significantly higher in those with severe acute respiratory syndrome than in those without it. Therefore, early elevated plasma fibrinogen level may be a risk marker for the severe acute respiratory syndrome development 42 . But there are also authors who found normal plasma fibrinogen levels 41 .…”

Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

Coagulation disorders in SARS-CoV-2 infection

Mihăilă¹,

Mihaila²

2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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A better understanding of the pathogenetic mechanisms triggered by SARS-CoV-2 infection may contribute to a more effective management of patients with COVID-19. Coagulation dysfunction is a key pathogenetic element of this disease as well as a challenge for practitioners. Marked inflammatory process found in severe forms of COVID-19, the complement activation, the cytokine storm, and disruption of the renin-angiotensin-aldosterone system are involved in the onset of thrombotic microangiopathy and large vessel coagulopathy. Virus-induced procoagulant activity occurs at the systemic level. Intravascular microthrombi disrupt vascularization in various tissues and organs, contributing to the occurrence of multiorgan failure and explain the higher morbidity and all-cause mortality of patients. It is estimated that almost 20% of patients with COVID-19 have significant coagulation disorders, and about a quarter of those hospitalized in intensive care units are prone to develop thrombosis events under prophylactic anticoagulant treatment. Some of patients who have been immunized after healing from the SARS-CoV-2 infection have a hypercoagulable state and are prone to develop thrombosis. Hypercoagulability is supported by thrombelastographic analysis: patients have an acceleration of the propagation phase of blood clot formation and higher clot strength. Markers of coagulation dysfunction in SARS-CoV2 are: decreased platelet count, increased INR, presence of fibrin degradation products, and especially higher plasma levels of D-dimers, which predict unfavorable outcome in these patients. Age, pre-existing diseases and associated risk factors, together with careful monitoring of clinical evolution and laboratory parameters allow the choice of the best personalized prophylactic or curative anticoagulant treatment.

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Section: Plasma Fibringen and D-dimer Levelsmentioning

confidence: 99%

Coagulation disorders in SARS-CoV-2 infection

Mihăilă¹,

Mihaila²

2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The reported incidence of thromboembolic complications in ICU patients with COVID-19 ranges from 21 to 69%, but these data are predominantly from single-centre studies [7][8][9][10][11]. Current research priorities include the optimal agent, dose and duration for prophylaxis and treatment of thrombosis, identification of clinical characteristics or biomarkers to aid risk stratification and the potential role of viscoelastic tests of coagulation [1,12,13].…”

Section: Introductionmentioning

confidence: 99%

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

et al. 2020

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Background Optimal prophylactic and therapeutic management of thromboembolic disease in patients with COVID-19 remains a major challenge for clinicians. The aim of this study was to define the incidence of thrombotic and haemorrhagic complications in critically ill patients with COVID-19. In addition, we sought to characterise coagulation profiles using thromboelastography and explore possible biological differences between patients with and without thrombotic complications. Methods We conducted a multicentre retrospective observational study evaluating all the COVID-19 patients received in four intensive care units (ICUs) of four tertiary hospitals in the UK between March 15, 2020, and May 05, 2020. Clinical characteristics, laboratory data, thromboelastography profiles and clinical outcome data were evaluated between patients with and without thrombotic complications. Results A total of 187 patients were included. Their median (interquartile (IQR)) age was 57 (49–64) years and 124 (66.3%) patients were male. Eighty-one (43.3%) patients experienced one or more clinically relevant thrombotic complications, which were mainly pulmonary emboli (n = 42 (22.5%)). Arterial embolic complications were reported in 25 (13.3%) patients. ICU length of stay was longer in patients with thrombotic complications when compared with those without. Fifteen (8.0%) patients experienced haemorrhagic complications, of which nine (4.8%) were classified as major bleeding. Thromboelastography demonstrated a hypercoagulable profile in patients tested but lacked discriminatory value between those with and without thrombotic complications. Patients who experienced thrombotic complications had higher D-dimer, ferritin, troponin and white cell count levels at ICU admission compared with those that did not. Conclusion Critically ill patients with COVID-19 experience high rates of venous and arterial thrombotic complications. The rates of bleeding may be higher than previously reported and re-iterate the need for randomised trials to better understand the risk-benefit ratio of different anticoagulation strategies. Graphical abstract

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“…Since early epidemiological reports, a hypercoagulable state characterized by increased levels of fibrinogen and D-dimer has been found in hospitalized COVID-19 patients [ 5 , 6 , 7 , 8 ]; moreover, an increased rate of pulmonary thrombi and emboli has been found in autoptical series [ 9 ], as also shown in other viral pandemicssuch as influenza A H1N1 [ 10 ]. Based on these data, clinical researchers focused their attention on life-threatening complications of the hypercoagulable state as pulmonary embolism (PE) or disseminated intravascular coagulation (DIC) [ 11 ].…”

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confidence: 97%

Venous Thromboembolism and Its Association with COVID-19: Still an Open Debate

2020

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Asreported by the World Health Organization, a novel coronavirus (COVID-19) was identified as the causative virus of new viral pneumonia of unknown etiology by Chinese authorities on 7 January 2020. The virus was named COVID-19 and because of its ability to cause severe acute respiratory syndrome (i.e., SARS) this infection has also been defined as SARS-CoV2.Furthermore, an association between COVID-19 infection and venous thromboembolism has been reported in several series around the world.For this reason, methods used to improve diagnostic tools, pharmacological thromboprophylaxis and type of anticoagulants are discussed in this expert opinion.

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Clotting Factors in COVID-19: Epidemiological Association and Prognostic Values in Different Clinical Presentations in an Italian Cohort

Cited by 77 publications

References 15 publications

Coagulation disorders in SARS-CoV-2 infection

Coagulation disorders in SARS-CoV-2 infection

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

Venous Thromboembolism and Its Association with COVID-19: Still an Open Debate

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