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Complex and prolonged hypercoagulability in coronavirus disease 2019 intensive care unit patients: A

Pierre-Yves Cordier1, Candice Pierrou1, Alexandre Noel1

  • 1Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France.

Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses
|January 29, 2021
PubMed

Insights

Critically ill patients with coronavirus disease 2019 (COVID-19) exhibit a prolonged hypercoagulable state, characterized by rapid clot formation and reinforcement. Further research is needed to explore antithrombotic strategies for these patients.

Area of Science:

  • Critical care medicine
  • Hematology
  • Infectious diseases

Background:

  • Critically ill patients with COVID-19 frequently experience thrombotic complications due to a hypercoagulable state.
  • Limited evidence exists for detecting, managing, and monitoring COVID-19-associated coagulopathy.
  • Understanding the mechanisms of hypercoagulability in COVID-19 is crucial.

Purpose of the Study:

  • To investigate the mechanisms of hypercoagulability in patients with COVID-19.
  • To describe the thrombus viscoelastic properties in COVID-19 patients.

Main Methods:

  • Thromboelastography (TEG) was performed on 24 intensive care unit (ICU) patients with COVID-19 pneumonia.
  • 10 patients underwent a second TEG before ICU discharge.
  • TEG results were compared to 20 healthy controls.

Main Results:

  • COVID-19 patients showed significantly decreased reaction time, coagulation time, and lysis index compared to controls.
  • Patients exhibited increased α angle, maximum amplitude, clot strength, and coagulation index.
  • Velocity curves indicated increased thrombin generation, persisting even in surviving patients.

Conclusions:

  • TEG reveals a complex, prolonged hypercoagulable state in COVID-19 patients, including rapid coagulation, clot reinforcement, low fibrinolysis, and high thrombin generation.
  • Fibrinogen and platelet contribution to clot strength is significant.
  • Further studies are required to investigate antithrombotic strategies for COVID-19 patients during and after ICU hospitalization.
Abstract

Keywords:
COVID-19CoagulopathyHypercoagulabilityThromboelastographyThrombosis

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