Critically ill COVID‐19 infected patients exhibit increased clot waveform analysis parameters consistent with hypercoagulability

Abstract

developed thrombosis, our patients' CWA parameters remained remarkably high despite the use of thromboprophylaxis during their ICU stay. It is possible that CWA and other thrombin generation assays might not be sensitive enough to detect the haemostatic changes caused by the standard prophylactic dose of low molecular weight heparin.All three patients recovered from COVID-19 infection.Thatour findings of markedly raised CWA parameters in critically ill infected cases are possibly consistent with hypercoagulability is not unexpected. Such patients exhibit hyperinflammation and cytokine overdrive, and extensive crosstalk is known to exist in the cytokines, the inflammatory system, and coagulation. 6 Critically ill COVID-19 patients have been shown to have increased proinflammatory cytokines including IL-2 and TNF-α, 4 and these factors could upregulate the coagulation system. 6 We speculate that this could partially account for the CWA changes observed.Although our findings are limited by the relatively few patients and data points and by the lack of other correlation studies with other coagulation assays, we believe there are still valuable points to take away. Many of the specialized and research haemostatic assays cannot be safely and easily performed on samples collected from COVID-19 patients in view of laboratory biosafety concerns. As COVID-19 infection is spreading relentlessly worldwide, there is an urgent need for rapid and readily accessible biomarkers that can aid clinical stratification and management. So, CWA represents a simple, automated and rapid test, which fulfills these biosafety criteria. Whenever an aPTT is performed, an aPTT waveform is generated automatically by commonly used optical analysers worldwide.In conclusion, the rise of CWA parameters precedes and coincides with ICU admission and warrant further study to confirm its utility in the routine management of COVID-19 patients.

Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal

“…Moreover, lung infiltrates appear to cause an "atypical" form of ARDS, in which an impressive shunt fraction (mean ± standard deviation; 0.50 ± 0.11) [4] is associated with a relatively high compliance (50.2 ± 14.3 mL/cmH 2 O) [4]. This event may be justified by the loss of lung perfusion regulation and hypoxic vasoconstriction [4], and by a hypercoagulability state [5] with consequent pulmonary microvascular coagulation. Post-mortem lung biopsies of COVID-19 patients demonstrated diffuse alveolar damage with cellular fibromyxoid exudates, interstitial lymphocytic infiltrates, desquamation of pneumocytes, and hyaline membrane formation [6].…”

Care of patients with hemoglobin disorders during the COVID‐19 pandemic: An overview of recommendations

“…There is a close association between elevated D-dimer levels and pro-inflammatory cytokines with disease severity in patients with COVID-19. 11 Blood tests on admission should include platelet count, fibrinogen, and D-dimer levels. It is also recommended to check D-dimer levels every 24-48 hours during hospitalization.…”

Initial Real-life Experience From a Designated COVID-19 Centre in Athens, Greece. A Proposed Therapeutic Algorithm

“…Another crucial point is particular attention to the guidelines on appropriate DVT prophylaxis. In a few patients who deteriorated, especially ones with higher body-mass index (BMI) and/or D-dimers more than 4-5 times the upper normal limit, we have used therapeutic doses of low molecular weight heparin until they recovered [22]. We have not had signi cant bleeding complications attributed to our practice.…”