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Published on: November 30, 2018
Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate
Itsuki Osawa1, Koh Okamoto2, Mahoko Ikeda1,3
1Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Insights
Clinical characteristics at admission can predict coagulopathy in coronavirus disease 2019 (COVID-19) patients treated with nafamostat mesylate. Subgroup analysis revealed distinct coagulation factor dynamics, informing risk stratification for better patient outcomes.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) is associated with hypercoagulable status, leading to critical illness.
- Limited understanding exists regarding coagulation factor dynamics in COVID-19 patients receiving nafamostat mesylate, a potential anticoagulant therapy.
Purpose of the Study:
- To retrospectively analyze clinical characteristics and dynamic changes in coagulation factors among COVID-19 patients treated with nafamostat mesylate.
- To identify patient subgroups based on admission characteristics and their association with coagulopathy and clinical outcomes.
Main Methods:
- Retrospective cluster analysis of 15 COVID-19 patients on nafamostat mesylate based on admission clinical features.
- Delineation of patient subgroup characteristics and comparison of dynamic changes in coagulation factors (fibrinogen, D-dimer).
- Graphical presentation of dynamic changes in fibrinogen and D-dimer levels.
Main Results:
- COVID-19 patients were classified into three risk subgroups (A: low, B: intermediate, C: high) based on admission characteristics.
- All patients survived 30 days; cluster A required no mechanical ventilation, while cluster C patients necessitated mechanical ventilation and/or ECMO.
- Cluster A maintained low D-dimer levels; critical patients in clusters B and C exhibited dynamic changes in fibrinogen and D-dimer.
Conclusions:
- Admission characteristics of COVID-19 patients can predict subsequent coagulopathy.
- Nafamostat mesylate's potential therapeutic role warrants further investigation in randomized clinical trials.
- Subgroup analysis highlights differential coagulation factor dynamics, aiding in risk stratification for COVID-19 patients.
Abstract:
Critical illnesses associated with coronavirus disease 2019 (COVID-19) are attributable to a hypercoagulable status. There is limited knowledge regarding the dynamic changes in coagulation factors among COVID-19 patients on nafamostat mesylate, a potential therapeutic anticoagulant for COVID-19. First, we retrospectively conducted a cluster analysis based on clinical characteristics on admission to identify latent subgroups among fifteen patients with COVID-19 on nafamostat mesylate at the University of Tokyo Hospital, Japan, between April 6 and May 31, 2020. Next, we delineated the characteristics of all patients as well as COVID-19-patient subgroups and compared dynamic changes in coagulation factors among each subgroup. The subsequent dynamic changes in fibrinogen and D-dimer levels were presented graphically. All COVID-19 patients were classified into three subgroups: clusters A, B, and C, representing low, intermediate, and high risk of poor outcomes, respectively. All patients were alive 30 days from symptom onset. No patient in cluster A required mechanical ventilation; however, all patients in cluster C required mechanical ventilation, and half of them were treated with venovenous extracorporeal membrane oxygenation. All patients in cluster A maintained low D-dimer levels, but some critical patients in clusters B and C showed dynamic changes in fibrinogen and D-dimer levels. Although the potential of nafamostat mesylate needs to be evaluated in randomized clinical trials, admission characteristics of patients with COVID-19 could predict subsequent coagulopathy.
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