Hypercoagulability of COVID‐19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis

Abstract

Background:The severe inflammatory state secondary to COVID-19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D-dimer, as well as low fibrinogen.Aims: Whole blood from 24 patients admitted at the intensive care unit because of COVID-19 was collected and evaluated with thromboelastography by the TEG pointof-care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis.Results: TEG parameters are consistent with a state of hypercoagulability as shown by decreased values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal).Fibrinogen was increased and D-dimer was dramatically increased. C-reactive protein was increased. Factor VIII and von Willebrand factor (n = 11) were increased. Antithrombin (n = 11) was marginally decreased and protein C (n = 11) was increased. Conclusion:The results of this cohort of patients with COVID-19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/ treatment. Clinical trials are urgently needed to establish the type of drug, dosage, and optimal duration of prophylaxis.

Modifiable and non-modifiable risk factors for COVID-19: results from UK Biobank

“…Furthermore, obesity enhances thrombosis 31 , which is relevant given the association between severe COVID-19 and pro-thrombotic disseminated intravascular coagulation and high rates of venous thromboembolism 32,33 , as well as the association with D-dimer seen in other reports 34 . D-dimer was not measured in blood samples in UK Biobank.…”

COVID-19 update: Covid-19-associated coagulopathy

“…The unique nature of Covid-19-associated coagulopathy and thrombophilia was underscored in a small case series by Panigada et al [86]. A total of 24 laboratory-confirmed patients was included.…”

Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19

“…Circulating monocytes, neutrophils, platelets and microparticles bind to the activated endothelium and locally provide TF and neutrophils extracellular traps (NETs) for initiation of coagulation via TF/FVIIa pathway. Consequently, excessive amounts of thrombin are generated with a subsequent hypercoagulability state [11] (Fig. 1).…”

“…High fibrinogen and D-dimer levels both reflect the hypercoagulable and inflammatory state. One question is whether the use of viscoelastic tests performed on whole blood could be helpful to both better explore hypercoagulability and predict thrombotic events in this setting [11]. Despite standard thromboprophylaxis using low molecular-weight heparin (LMWH) or unfractionated heparin (UFH), the prevalence of thrombotic events is unusually high: a more aggressive thromboprophylaxis using LMWH or UFH could be considered on an individual basis, especially in patients with multiple risk factors for thromboembolism (i.e., obesity, cancer, etc.)…”