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The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome.
Ranucci, Marco; Ballotta, Andrea; Di Dedda, Umberto; Baryshnikova, Ekaterina; Dei Poli, Marco; Resta, Marco; Falco, Mara; Albano, Giovanni; Menicanti, Lorenzo.
  • Ranucci M; Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
  • Ballotta A; Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
  • Di Dedda U; Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
  • Baryshnikova E; Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
  • Dei Poli M; Department of General Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
  • Resta M; Department of General Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
  • Falco M; Department of Radiology, Koelliker Hospital, Turin, Italy.
  • Albano G; Anesthesia and Intensive Care Department, Humanitas Gavazzeni Clinic, Bergamo, Italy.
  • Menicanti L; Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy.
J Thromb Haemost ; 18(7): 1747-1751, 2020 07.
Article in English | MEDLINE | ID: covidwho-1317985
ABSTRACT

BACKGROUND:

Few observations exist with respect to the pro-coagulant profile of patients with COVID-19 acute respiratory distress syndrome (ARDS). Reports of thromboembolic complications are scarce but suggestive for a clinical relevance of the problem.

OBJECTIVES:

Prospective observational study aimed to characterize the coagulation profile of COVID-19 ARDS patients with standard and viscoelastic coagulation tests and to evaluate their changes after establishment of an aggressive thromboprophylaxis.

METHODS:

Sixteen patients with COVID-19 ARDS received a complete coagulation profile at the admission in the intensive care unit. Ten patients were followed in the subsequent 7 days, after increasing the dose of low molecular weight heparin, antithrombin levels correction, and clopidogrel in selected cases.

RESULTS:

At baseline, the patients showed a pro-coagulant profile characterized by an increased clot strength (CS, median 55 hPa, 95% interquartile range 35-63), platelet contribution to CS (PCS, 43 hPa; interquartile range 24-45), fibrinogen contribution to CS (FCS, 12 hPa; interquartile range 6-13.5) elevated D-dimer levels (5.5 µg/mL, interquartile range 2.5-6.5), and hyperfibrinogenemia (794 mg/dL, interquartile range 583-933). Fibrinogen levels were associated (R2  = .506, P = .003) with interleukin-6 values. After increasing the thromboprophylaxis, there was a significant (P = .001) time-related decrease of fibrinogen levels, D-dimers (P = .017), CS (P = .013), PCS (P = .035), and FCS (P = .038).

CONCLUSION:

The pro-coagulant pattern of these patients may justify the clinical reports of thromboembolic complications (pulmonary embolism) during the course of the disease. Further studies are needed to assess the best prophylaxis and treatment of this condition.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Blood Coagulation / Blood Coagulation Disorders / Coronavirus Infections / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Thromb Haemost Journal subject: Hematology Year: 2020 Document Type: Article Affiliation country: Jth.14854

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Blood Coagulation / Blood Coagulation Disorders / Coronavirus Infections / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Thromb Haemost Journal subject: Hematology Year: 2020 Document Type: Article Affiliation country: Jth.14854