The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome

Marco Ranucci, Andrea Ballotta, Umberto Di Dedda, Ekaterina Baryshnikova, Marco Dei Poli, Marco Resta, Mara Falco, Giovanni Albano, Lorenzo Menicanti, Marco Ranucci, Andrea Ballotta, Umberto Di Dedda, Ekaterina Baryshnikova, Marco Dei Poli, Marco Resta, Mara Falco, Giovanni Albano, Lorenzo Menicanti

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.

Keywords: COVID-19; D-dimer; acute respiratory distress syndrome; coagulation parameter; viscoelastic tests.

© 2020 International Society on Thrombosis and Haemostasis.

Figures

FIGURE 1
FIGURE 1
Association between interleukin‐6 values and fibrinogen levels. Logarithmic regression; gray area is 95% confidence interval
FIGURE 2
FIGURE 2
Baseline viscoelastic parameters. Boxes represent median and interquartile range, whiskers minimum to maximum values. CT, clotting time (left Y axis); CS, clot strength; FCS, fibrinogen contribution to clot strength; PCS, platelet contribution to clot strength (right Y axis). Colored areas are normal range. The numbers after the variables on the X‐axis express baseline (1) and follow‐up at 2 weeks (2)
FIGURE 3
FIGURE 3
Time course of coagulation parameters. Boxes represent median and interquartile range, whiskers minimum to maximum values. aPTT, activated partial thromboplastin time; ICU, intensive care unit. Dashed line represents onset of enhanced anti‐thrombotic prophylaxis

References

    1. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
    1. Chen N., Zhou M., Dong X., et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513.
    1. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–847.
    1. Guan W.J., Ni Z.Y., Hu Y., et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720.
    1. Zhou F., Yu T., Du R., et al. Clinical course and risk factors for mortality of adult inpatients with COVID‐19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062.
    1. Xie Y., Wang X., Yang P., Zhang S. COVID‐19 complicated by acute pulmonary embolism. Radiol Cardiothorac Imaging. 2020;2(2)
    1. ECMO and COVID‐19. Experience from Paris. EuroELSO Webinar, . Accessed April 3, 2020.
    1. Ferrante E.A., Blasier K.R., Givens T.B., et al. A novel device for evaluation of hemostatic function in critical care settings. Anesth Analg. 2016;123:1372–1379.
    1. Kerr R., Stirling D., Ludlam C.A. Interleukin 6 and haemostasis. Br J Haematol. 2001;115:3–12.
    1. Bode M., Mackman N. Regulation of tissue factor gene expression in monocytes and endothelial cells: thromboxane A2 as a new player. Vascul Pharmacol. 2014;62:57–62.
    1. Ishiguro T., Matsuo K., Fujii S., Takayanagi N. Acute thrombotic vascular events complicating influenza‐associated pneumonia. Respir Med Case Rep. 2019;28:100884.
    1. Thachil J., Wada H., Gando S., et al. ISTH interim guidance on recognition and management of coagulopathy in COVID‐19. J Thromb Haemost. 2020;18:1023–1026.
    1. Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18:1094–1099.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する