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Hypercoagulability in critically ill patients with COVID 19, an observational prospective study.
Calvet, Laure; Thouy, François; Mascle, Olivier; Sapin, Anne-Françoise; Grapin, Kévin; Liteaudon, Jean Mathias; Evrard, Bertrand; Bonnet, Benjamin; Adda, Mireille; Souweine, Bertrand; Dupuis, Claire.
  • Calvet L; Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
  • Thouy F; Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
  • Mascle O; Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
  • Sapin AF; Laboratoire d'hématologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
  • Grapin K; Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
  • Liteaudon JM; Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
  • Evrard B; Service d'Immunologie, CHU Gabriel-Montpied, Clermont-Ferrand, France.
  • Bonnet B; Laboratoire d'Immunologie, ECREIN, UMR1019 UNH, UFR Médecine de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
  • Adda M; Service d'Immunologie, CHU Gabriel-Montpied, Clermont-Ferrand, France.
  • Souweine B; Laboratoire d'Immunologie, ECREIN, UMR1019 UNH, UFR Médecine de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
  • Dupuis C; Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
PLoS One ; 17(11): e0277544, 2022.
Article in English | MEDLINE | ID: covidwho-2140651
ABSTRACT

OBJECTIVE:

COVID 19 is often associated with hypercoagulability and thromboembolic (TE) events. The aim of this study was to assess the characteristics of hypercoagulability and its relationship with new-onset TE events and the composite outcome of need for intubation and/or death in intensive care unit (ICU) patients admitted for COVID.

DESIGN:

Prospective observational study.

SETTING:

Monocentric, intensive care, University Hospital of Clermont Ferrand, France. PATIENTS Patients admitted to intensive care from January 2020 to May 2021 for COVID-19 pneumonia.

INTERVENTIONS:

Standard hemostatic tests and rotational thromboelastometry (ROTEM) were performed on admission and on day 4. Hypercoagulability was defined by at least one of the following criteria D-dimers > 3000 µg/dL, fibrinogen > 8 g/L, EXTEM CFT below the normal range, EXTEM A5, MCF, Li 60 above the normal range, and EXTEM G-score ((5000 x MCF) / (100-MCF)) ≥ 11 dyne/cm2. MEASUREMENTS AND MAIN

RESULTS:

Of the 133 patients included, 17 (12.7%) developed new-onset TE events, and 59 (44.3%) required intubation and/or died in the ICU. ROTEM was performed in 133 patients on day 1 and in 67 on day 4. Hypercoagulability was present on day 1 in 115 (86.4%) patients. None of the hypercoagulability indices were associated with subsequent new-onset TE events on days 1 and 4 nor with the need for intubation and/or ICU death. Hyperfibrinogenemia > 8g/dL, higher D-dimers and higher EXTEM Li 60 on day 4 were predictive of need for intubation and/or of ICU death.

CONCLUSIONS:

Our study confirmed that most COVID-19 ICU patients have hypercoagulability on admission and almost all on day 4. Hyperfibrinogenemia or fibrinolysis shutdown on day 4 were associated with unfavorable outcome.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Thromboembolism / Blood Coagulation Disorders / Hemostatics / Thrombophilia / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0277544

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thromboembolism / Blood Coagulation Disorders / Hemostatics / Thrombophilia / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0277544