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Point of care diagnostic of hypercoagulability and platelet function in COVID-19 induced acute respiratory distress syndrome: a retrospective observational study.
Herrmann, Johannes; Notz, Quirin; Schlesinger, Tobias; Stumpner, Jan; Kredel, Markus; Sitter, Magdalena; Schmid, Benedikt; Kranke, Peter; Schulze, Harald; Meybohm, Patrick; Lotz, Christopher.
  • Herrmann J; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany. Herrmann_J4@ukw.de.
  • Notz Q; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Schlesinger T; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Stumpner J; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Kredel M; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Sitter M; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Schmid B; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Kranke P; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Schulze H; Institute of Experimental Biomedicine, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany.
  • Meybohm P; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
  • Lotz C; Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
Thromb J ; 19(1): 39, 2021 Jun 02.
Article in English | MEDLINE | ID: covidwho-1255939
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT.

METHODS:

This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020.

RESULTS:

Median age was 61 years (IQR 51-69). Median PaO2/FiO2 on admission was 122 mmHg (IQR 87-189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD 3.7; 95 %CI 1.3-10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications.

CONCLUSIONS:

Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications..
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Observational study / Prognostic study Language: English Journal: Thromb J Year: 2021 Document Type: Article Affiliation country: S12959-021-00293-8

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Observational study / Prognostic study Language: English Journal: Thromb J Year: 2021 Document Type: Article Affiliation country: S12959-021-00293-8