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Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study
Thiago Domingos Corrêa1, Ricardo Luiz Cordioli1, João Carlos Campos Guerra2
1Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Insights
COVID-19 patients exhibit significant hypercoagulability, marked by reduced natural anticoagulation and fibrinolysis. These coagulation abnormalities correlate with the severity of organ dysfunction in intensive care unit patients.
Area of Science:
- Critical Care Medicine
- Hematology
- Infectious Diseases
Background:
- Coagulation abnormalities in COVID-19 patients require deeper investigation.
- Understanding these changes is crucial for managing critically ill patients.
Purpose of the Study:
- To longitudinally evaluate the coagulation profile of intensive care unit (ICU) patients with COVID-19.
- To assess the impact of disease severity on coagulation parameters.
Main Methods:
- Longitudinal study of 30 ICU patients with COVID-19.
- Assessed conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, and endogenous anticoagulation markers (antithrombin, protein C, protein S) at multiple time points (Days 0, 1, 3, 7, 14).
- Patients stratified into two groups based on Sequential Organ Failure Assessment (SOFA) scores (≤10 and >10) to correlate coagulation changes with organ dysfunction severity.
Main Results:
- While some conventional tests remained stable, others showed significant alterations.
- Increased fibrinogen levels and enhanced clot firmness (ROTEM maximum clot firmness) were observed in both groups.
- Decreased fibrinolysis and low levels of free protein S and protein C were noted, particularly in patients with higher SOFA scores, indicating impaired endogenous anticoagulation and reduced fibrinolytic activity.
- D-dimer levels were elevated, consistent with a hypercoagulable state.
Conclusions:
- COVID-19 patients present a significant hypercoagulability state.
- This state is characterized by impaired endogenous anticoagulation and decreased fibrinolysis.
- The severity of coagulation abnormalities appears to correlate with the degree of organ dysfunction, suggesting a complex interplay between infection, inflammation, and the hemostatic system.
Background:
Coagulation abnormalities in COVID-19 patients have not been addressed in depth.
Objective:
To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19.
Methods:
Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10.
Results:
Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM-FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability.
Conclusion:
COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.
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