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Impaired fibrinolysis in critically ill COVID-19 patients

Mirjam Bachler1, Johannes Bösch2, Daniel P Stürzel2

  • 1Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall, Austria.

British Journal of Anaesthesia
|January 10, 2021
PubMed

Insights

Critically ill COVID-19 patients exhibit impaired fibrinolysis, a hypofibrinolytic state contributing to thrombosis. This impaired fibrinolysis may stem from a reduced fibrinolytic response, impacting coagulation.

Area of Science:

  • Coagulation and Thrombosis
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Critically ill COVID-19 patients often experience a hypercoagulable state, leading to significant macrovascular and microvascular thrombosis.
  • Hypofibrinolysis, or impaired clot breakdown, is suspected as a key factor contributing to this thrombotic tendency.

Purpose of the Study:

  • To investigate the fibrinolytic function in critically ill COVID-19 patients using viscoelastic whole blood analysis.
  • To compare the fibrinolytic response of COVID-19 patients with that of healthy individuals.

Main Methods:

  • Retrospective analysis of 20 critically ill COVID-19 patients and 60 healthy controls.
  • Coagulation function assessed using the ClotPro® device, including the TPA test to evaluate fibrinolysis.
  • Key parameters measured: lysis time (LT), maximum clot firmness (MCF), and maximum lysis (ML).

Main Results:

  • COVID-19 patients demonstrated hypercoagulability across multiple ClotPro® assays (EX, IN, FIB tests).
  • A decreased fibrinolytic response was observed in COVID-19 patients, indicated by prolonged TPA test LT and decreased ML in the EX test.
  • Patients with impaired fibrinolysis showed elevated fibrinogen, thrombocyte count, and C-reactive protein levels.

Conclusions:

  • Critically ill COVID-19 patients present with significantly impaired fibrinolysis.
  • This hypofibrinolytic state appears to be, at least partially, driven by a diminished fibrinolytic response, contributing to thrombotic complications.
Abstract

Keywords:
COVID-19D-dimercoagulationcritically illfibrinogenfibrinolysistissue plasminogen activatorviscoelastic test

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