ABSTRACT
Background : SARS-CoV-2 virus infection (COVID-19) is associated with high rates of venous thromboembolism (VTE). Immune mediated thrombosis has been implicated as a driving factor. Aims : To characterize coagulopathy by assessing thrombin generation kinetics and Von Willebrand Factor (VWF) and to characterize thromboinflammation through neutrophil extracellular trap (NET) formation in COVID-19 patients (pts). Methods : We collected plasma samples from 67 COVID-19 pts in the Emergency Department (ED) and 38 healthy volunteers (HV). Plasma thrombin generation kinetics were assessed using Calibrated Automated Thrombogram (CAT) and expressed as lag time (LT), peak height (PH), time to peak (ttPeak), and endogenous thrombin potential (ETP-total thrombin generated). NET formation was quantified through citrullinated nucleosome ELISA (H3NUC). VWF antigen/activity levels were determined by latex immunoassay. Factor VIII levels were performed using one-stage optical clot detection. VTE events were tracked through electronic medical records. This study was approved by the Institutional Review Board and patients were consented. Mann-Whitney test was performed, P < 0.05 considered significant. Results : Subject characteristics are described in Table 1. Of the 67 pts, 50.7% required admission and 31.3% supplemental oxygen. COVID-19 pts had longer LT and ttPeak, greater H3NUC, VWF antigen and activity level, and Factor VIII levels as compared to HV (Table 2). Admitted pts had longer LT (4.33 min [3.67, 5.67];3.33 min [3.00, 4.00], P < 0.001), ttPeak (7.73 min [6.84, 8.50];7.15 min [6.05, 7.75], P = 0.011), greater VWF antigen (247 IU/dL [208, 298];168 IU/ dL [103, 222], P < 0.001), activity (196 IU/dL [164, 238];130 IU/dL [94, 172], P < 0.001), and Factor VIII (159 IU/dL [129, 194];119 IU/dL [88, 169], P = 0.023) as compared to those not admitted. Conclusions : Symptomatic COVID-19 pts have prolonged initiation of thrombin generation, especially those requiring admission. Greater VWF activity and NETosis suggest systemic thromboinflammation in COVID-19 associated coagulopathy.
ABSTRACT
A gap in knowledge exists regarding drug use among drivers and other road users (pedestrians, bicyclists) who are seriously or fatally injured in crashes in the United States. This study examines the prevalence of alcohol as well as selected over-the-counter, prescription, and illegal drugs in the blood of seriously or fatally injured drivers and other crash victims near the time of their crashes before and during the COVID-19 public health emergency. Data was collected at Level 1 trauma centers and medical examiner offices. The 3,003 participants represent a convenience sample of roadway users who were seriously or fatally injured during the study period. Trauma centers and medical examiners made available small volumes of blood for toxicological analyses from the total collected during their normal clinical procedures. The results indicate drug prevalence was high among seriously and fatally injured roadway users before the public health emergency began and was even higher during, especially for alcohol, cannabinoids (active THC), and opioids. Drivers in particular showed significantly higher overall drug prevalence during the public health emergency, with 64.7% testing positive for at least one active drug, compared to 50.8% before. Drivers also showed an increase in testing positive for two or more categories of drugs going from 17.6% before to 25.3% during the public health emergency. Of particular note, active THC was more prevalent among drivers during the public health emergency than alcohol (32.7% versus 28.3%), and opioid use among drivers almost doubled from 7.5% to 13.9%. Overall, the results of this study suggest the highway safety community should be concerned about the impact of other drugs as well as alcohol. In particular, the observed cannabis and opioid prevalence rates before and during the public health emergency could be indicative of a growing problem. These findings are prevalence rates only and cannot be used to determine whether the people were impaired at the time of their crash.