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Association between Thrombin Generation and Clinical Characteristics in COVID-19 Patients
Omri Cohen1,2,3, Nitsan Landau2,4, Einat Avisahai1,2
1National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel.
Insights
Thrombin generation (TG) capacity in COVID-19 patients did not correlate with disease severity. However, endogenous thrombin potential (ETP) showed a correlation with the sepsis-induced coagulopathy (SIC) score.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) is linked to coagulopathy and thrombosis.
- The relationship between thrombin generation (TG) capacity, COVID-19 severity, and outcomes requires further elucidation.
Purpose of the Study:
- To investigate the correlation of TG capacity with disease severity scores (SOFA, SIC) and clinical outcomes in hospitalized COVID-19 patients.
- To assess the impact of anticoagulant therapy on TG parameters.
Main Methods:
- Plasma samples from hospitalized COVID-19 patients were analyzed for TG parameters.
- Correlation analysis was performed between TG parameters, SOFA scores, SIC scores, and clinical outcomes.
- TG parameters were compared between patients receiving different doses of anticoagulant therapy and healthy controls.
Main Results:
- No significant correlation was found between TG parameters and SOFA scores or mortality.
- Patients receiving higher anticoagulant doses showed increased lag time, reduced ETP, and lower peak height.
- ETP demonstrated a significant correlation with the SIC score (p = 0.038).
Conclusions:
- TG capacity is not associated with COVID-19 disease severity.
- A notable correlation exists between ETP and the SIC score, warranting further investigation.
Introduction:
Coronavirus disease 2019 (COVID-19) disease is associated with coagulopathy and an increased risk of thrombosis. An association between thrombin generation (TG) capacity, disease severity, and outcomes has not been well described.
Methods:
We assessed the correlation of TG with sequential organ failure assessment (SOFA) and sepsis-induced coagulopathy (SIC) scores and clinical outcomes by analysis of plasma samples obtained from hospitalized COVID-19 patients.
Results:
32 patients (68.8% male), whose median age was 69 years, were assessed, of whom only 3 patients did not receive anticoagulant therapy. D-dimers were uniformly increased. During hospitalization, 2 patients suffered thrombosis, 3 experienced bleeding, and 12 died. TG parameters from anticoagulated COVID-19 patients did not significantly differ from the values obtained from non-anticoagulated healthy controls. Patients who received higher than prophylactic doses of anticoagulant therapy had increased lag time (p = 0.003), lower endogenous thrombin potential (ETP) (p = 0.037), and a reduced peak height (p = 0.006). ETP correlated with the SIC score (p = 0.038). None of the TG parameters correlated with the SOFA score or were associated with mortality.
Conclusion:
TG was not associated with disease severity among patients hospitalized with COVID-19. However, a correlation between ETP and the SIC score was noted and deserves attention.
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