Related Experiment Video
Updated: Dec 12, 2025
Author Spotlight: Advancing Thrombolytic Testing by Integrating Flow Dynamics in In Vitro Models
Published on: April 19, 2024
Fibrinolysis Shutdown and Thrombosis in a COVID-19 ICU
Christina Creel-Bulos1, Sara C Auld2,3, Mark Caridi-Scheible1
1Emory Critical Care Center, Division of Critical Care Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.
Insights
COVID-19 patients often experience fibrinolysis shutdown, a condition of impaired blood clot breakdown. Viscoelastic testing can identify this hypercoagulable state, potentially guiding treatment with clot-dissolving medications.
Area of Science:
- Critical care medicine
- Hematology
- Infectious diseases
Background:
- The COVID-19 pandemic has been associated with severe systemic inflammation and a high incidence of thrombotic events.
- Traditional coagulation tests may not fully capture the hypercoagulable state observed in critically ill COVID-19 patients.
Purpose of the Study:
- To determine the prevalence of fibrinolysis shutdown in intensive care unit (ICU) patients with COVID-19.
- To evaluate the utility of rotational thromboelastometry (ROTEM) in identifying impaired fibrinolysis in this population.
Main Methods:
- Rotational thromboelastometry (ROTEM) was used to assess fibrinolysis in 25 ICU patients over 3 weeks.
- Patients were evaluated for criteria indicative of fibrinolysis shutdown.
Main Results:
- Fibrinolysis shutdown was identified in 11 out of 25 (44%) of the tested COVID-19 patients.
- A higher prevalence was observed in patients with venous thromboembolism (VTE), with 8 out of 9 (73%) meeting shutdown criteria.
Conclusions:
- Viscoelastic testing, such as ROTEM, is a valuable tool for detecting impaired fibrinolysis in critically ill COVID-19 patients.
- Identifying patients with fibrinolysis shutdown may help in selecting candidates for fibrinolytic therapy.
Abstract:
The coronavirus disease (COVID-19) pandemic has threatened millions of lives worldwide with severe systemic inflammation, organ dysfunction, and thromboembolic disease. Within our institution, many critically ill COVID-19-positive patients suffered major thrombotic events, prompting our clinicians to evaluate hypercoagulability outside of traditional coagulation testing.We determined the prevalence of fibrinolysis shutdown via rotational thromboelastometry (ROTEM, Instrumentation Laboratories, Bedford, Mass) in patients admitted to the intensive care unit over a period of 3 weeks. In 25 patients who had a ROTEM test, we found that 11 (44%) met criteria for fibrinolysis shutdown. Eight of 9 (73%) of the VTE patients met criteria for fibrinolysis shutdown.Given the high rate of fibrinolysis shutdown in these patients, our data support using viscoelastic testing to evaluate for the presence of impaired fibrinolysis. This may help identify patient subsets who might benefit from the administration of fibrinolytics.
Related Concept Videos
01:16Clot Retraction and Fibrinolysis
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...