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Impaired fibrinolysis in critically ill COVID-19 patients.
Bachler, Mirjam; Bösch, Johannes; Stürzel, Daniel P; Hell, Tobias; Giebl, Andreas; Ströhle, Mathias; Klein, Sebastian J; Schäfer, Volker; Lehner, Georg F; Joannidis, Michael; Thomé, Claudius; Fries, Dietmar.
  • Bachler M; Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall, Austria.
  • Bösch J; Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria. Electronic address: johannes.boesch@i-med.ac.at.
  • Stürzel DP; Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria.
  • Hell T; Department of Mathematics, University of Innsbruck, Innsbruck, Austria.
  • Giebl A; Department of Transfusion Medicine and Haemostaseology, Augsburg University Clinic, Augsburg, Germany.
  • Ströhle M; Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria.
  • Klein SJ; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Innsbruck, Austria.
  • Schäfer V; Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria.
  • Lehner GF; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Innsbruck, Austria.
  • Joannidis M; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Innsbruck, Austria.
  • Thomé C; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
  • Fries D; Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria.
Br J Anaesth ; 126(3): 590-598, 2021 03.
Article in English | MEDLINE | ID: covidwho-965444
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Fibrinolysis PROCESS_OF Patients
Subject
Fibrinolysis
Predicate
PROCESS_OF
Object
Patients
3. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
4. Laboratory Procedures USES alteplase|PLAT
Subject
Laboratory Procedures
Predicate
USES
Object
alteplase|PLAT
5. alteplase CAUSES Fibrinolysis
Subject
alteplase
Predicate
CAUSES
Object
Fibrinolysis
6. Laboratory Procedures USES FBL gene|FBL
Subject
Laboratory Procedures
Predicate
USES
Object
FBL gene|FBL
7. Assay USES Functional Fibrinogen Measurement
Subject
Assay
Predicate
USES
Object
Functional Fibrinogen Measurement
8. Responsive Disease PROCESS_OF Patients
Subject
Responsive Disease
Predicate
PROCESS_OF
Object
Patients
9. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
10. Fibrinolysis PROCESS_OF Patients
Subject
Fibrinolysis
Predicate
PROCESS_OF
Object
Patients
11. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
12. Laboratory Procedures USES alteplase|PLAT
Subject
Laboratory Procedures
Predicate
USES
Object
alteplase|PLAT
13. alteplase CAUSES Fibrinolysis
Subject
alteplase
Predicate
CAUSES
Object
Fibrinolysis
14. Laboratory Procedures USES FBL gene|FBL
Subject
Laboratory Procedures
Predicate
USES
Object
FBL gene|FBL
15. Assay USES Functional Fibrinogen Measurement
Subject
Assay
Predicate
USES
Object
Functional Fibrinogen Measurement
16. Responsive Disease PROCESS_OF Patients
Subject
Responsive Disease
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

BACKGROUND:

Critically ill coronavirus disease 2019 (COVID-19) patients present with a hypercoagulable state with high rates of macrovascular and microvascular thrombosis, for which hypofibrinolysis might be an important contributing factor.

METHODS:

We retrospectively analysed 20 critically ill COVID-19 patients at Innsbruck Medical University Hospital whose coagulation function was tested with ClotPro® and compared with that of 60 healthy individuals at Augsburg University Clinic. ClotPro is a viscoelastic whole blood coagulation testing device. It includes the TPA test, which uses tissue factor (TF)-activated whole blood with added recombinant tissue-derived plasminogen activator (r-tPA) to induce fibrinolysis. For this purpose, the lysis time (LT) is measured as the time from when maximum clot firmness (MCF) is reached until MCF falls by 50%. We compared COVID-19 patients with prolonged LT in the TPA test and those with normal LT.

RESULTS:

Critically ill COVID-19 patients showed hypercoagulability in ClotPro assays. MCF was higher in the EX test (TF-activated assay), IN test (ellagic acid-activated assay), and FIB test (functional fibrinogen assay) with decreased maximum lysis (ML) in the EX test (hypofibrinolysis) and highly prolonged TPA test LT (decreased fibrinolytic response), as compared with healthy persons. COVID-19 patients with decreased fibrinolytic response showed higher fibrinogen levels, higher thrombocyte count, higher C-reactive protein levels, and decreased ML in the EX test and IN test.

CONCLUSION:

Critically ill COVID-19 patients have impaired fibrinolysis. This hypofibrinolytic state could be at least partially dependent on a decreased fibrinolytic response.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / Thrombophilia / Fibrinolysis / COVID-19 Type of study: Diagnostic study / Observational study / Risk factors Topics: Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Br J Anaesth Year: 2021 Document Type: Article Affiliation country: J.bja.2020.12.010

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / Thrombophilia / Fibrinolysis / COVID-19 Type of study: Diagnostic study / Observational study / Risk factors Topics: Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Br J Anaesth Year: 2021 Document Type: Article Affiliation country: J.bja.2020.12.010