Hypercoagulability in critically ill patients with COVID 19, an observational prospective study

Abstract

Objective COVID 19 is often associated with hypercoagulability and thromboembolic (TE) events. The aim of this study was to assess the characteristics of hypercoagulability and its relationship with new-onset TE events and the composite outcome of need for intubation and/or death in intensive care unit (ICU) patients admitted for COVID. Design Prospective observational study. Setting Monocentric, intensive care, University Hospital of Clermont Ferrand, France. Patients Patients admitted to intensive care from January 2020 to May 2021 for COVID-19 pneumonia. Interventions Standard hemostatic tests and rotational thromboelastometry (ROTEM) were performed on admission and on day 4. Hypercoagulability was defined by at least one of the following criteria: D-dimers > 3000 μg/dL, fibrinogen > 8 g/L, EXTEM CFT below the normal range, EXTEM A5, MCF, Li 60 above the normal range, and EXTEM G-score ((5000 x MCF) / (100-MCF)) ≥ 11 dyne/cm2. Measurements and main results Of the 133 patients included, 17 (12.7%) developed new-onset TE events, and 59 (44.3%) required intubation and/or died in the ICU. ROTEM was performed in 133 patients on day 1 and in 67 on day 4. Hypercoagulability was present on day 1 in 115 (86.4%) patients. None of the hypercoagulability indices were associated with subsequent new-onset TE events on days 1 and 4 nor with the need for intubation and/or ICU death. Hyperfibrinogenemia > 8g/dL, higher D-dimers and higher EXTEM Li 60 on day 4 were predictive of need for intubation and/or of ICU death. Conclusions Our study confirmed that most COVID-19 ICU patients have hypercoagulability on admission and almost all on day 4. Hyperfibrinogenemia or fibrinolysis shutdown on day 4 were associated with unfavorable outcome.

Mechanisms of endothelial activation, hypercoagulation and thrombosis in COVID-19: a link with diabetes mellitus

“…In addition, elevated fibrinogen and D-dimer levels were correlated with hypercoagulable states, inflammation, and unfavorable outcomes after COVID-19 [ 117 ]. The increased D-dimer paradoxically coincided with decreased fibrinolytic capacity [ 117 , 118 ].…”

“…In addition, elevated fibrinogen and D-dimer levels were correlated with hypercoagulable states, inflammation, and unfavorable outcomes after COVID-19 [ 117 ]. The increased D-dimer paradoxically coincided with decreased fibrinolytic capacity [ 117 , 118 ]. Possibly, the presence of elevated D-dimer, especially during the early stages of pulmonary disease, could indicate the efforts of the local fibrinolytic system to eliminate fibrin and the necrotic tissue from the affected pulmonary parenchyma [ 118 ].…”

Star-polymers as potent broad-spectrum extracellular virucidal antivirals

“…Hypercoagulability, where blood tends towards heavy clotting, is particularly common after injury or infection, affecting approximately 1 in 500 people. [62][63][64] In normal blood, 0.06 mg/ml star-PSS slightly prolonged R and K and reduced a and MA, showing minor anti-coagulation effects without preventing viable clot formation (Figure 4C, turquoise triangles). At 0.1 mg/ml, clot strength was insufficient, although the typical clotting pattern was maintained (Figure 4C, yellow triangles).…”

Fibrinogen Levels in Patients with Metastatic Renal Cell Carcinoma Treated with Nivolumab: Results of a Multicenter Prospective Trial

“…Several studies have found a dose effect with an increased risk of myocardial infarction and death in patients with the elevated plasma fibrinogen levels [5]. Also, other diseases, such as infections and autoimmune diseases, can lead to an increase in fibrinogen levels [6][7][8]. During the systemic inflammatory process, high concentrations of cytokines appear, which are a trigger for the development of coagulopathy.…”