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Critical care (London, England)
12 07, 2020;24 (1): 676.

Thromboembolic complications in critically ill COVID-19 patients are associated with impaired fibrinolysis.

Jan Matthias Kruse, Abakar Magomedov, Annika Kurreck, Frédéric H Münch, Roland Koerner, Julian Kamhieh-Milz, Andreas Kahl, Inka Gotthardt, Sophie K Piper, Kai-Uwe Eckardt, Thomas Dörner, Daniel Zickler
Author Information
  1. Jan Matthias Kruse: Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  2. Abakar Magomedov: Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  3. Annika Kurreck: Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  4. Frédéric H Münch: Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  5. Roland Koerner: Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  6. Julian Kamhieh-Milz: Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  7. Andreas Kahl: Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  8. Inka Gotthardt: Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  9. Sophie K Piper: Institute of Biometry and Clinical Epidemiology, Charité - Universitätmedizin Berlin, Berlin, Germany.
  10. Kai-Uwe Eckardt: Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  11. Thomas Dörner: Department of Rheumatology Und Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  12. Daniel Zickler: Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. daniel.zickler@charite.de. ORCID
PMID: 33287877 DOI: 10.1186/s13054-020-03401-8

Abstract

BACKGROUND: There is emerging evidence for enhanced blood coagulation in coronavirus 2019 (COVID-19) patients, with thromboembolic complications contributing to morbidity and mortality. The mechanisms underlying this prothrombotic state remain enigmatic. Further data to guide anticoagulation strategies are urgently required.
METHODS: We used viscoelastic rotational thromboelastometry (ROTEM) in a single-center cohort of 40 critically ill COVID-19 patients.
RESULTS: Clear signs of a hypercoagulable state due to severe hypofibrinolysis were found. Maximum lysis, especially following stimulation of the extrinsic coagulation system, was inversely associated with an enhanced risk of thromboembolic complications. Combining values for maximum lysis with D-dimer concentrations revealed high sensitivity and specificity of thromboembolic risk prediction.
CONCLUSIONS: The study identifies a reduction in fibrinolysis as an important mechanism in COVID-19-associated coagulopathy. The combination of ROTEM and D-dimer concentrations may prove valuable in identifying patients requiring higher intensity anticoagulation.

Keywords

COVID-19 Coagulopathy D-dimers Hypofibrinolysis ROTEM

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MeSH Term

Blood Coagulation
Blood Coagulation Tests
COVID-19
Cohort Studies
Critical Illness
Female
Fibrinolysis
Humans
Male
Middle Aged
Point-of-Care Systems
Thrombelastography
Thromboembolism
Viscoelastic Substances

Chemicals

Viscoelastic Substances
Journal Article
Article has an altmetric score of 34

Word Cloud

Created with Highcharts 10.0.0COVID-19patientsthromboemboliccomplicationsROTEMenhancedcoagulationstateanticoagulationcriticallyilllysisassociatedriskD-dimerconcentrationsfibrinolysisBACKGROUND:emergingevidencebloodcoronavirus2019contributingmorbiditymortalitymechanismsunderlyingprothromboticremainenigmaticdataguidestrategiesurgentlyrequiredMETHODS:usedviscoelasticrotationalthromboelastometrysingle-centercohort40RESULTS:ClearsignshypercoagulabledueseverehypofibrinolysisfoundMaximumespeciallyfollowingstimulationextrinsicsysteminverselyCombiningvaluesmaximumrevealedhighsensitivityspecificitypredictionCONCLUSIONS:studyidentifiesreductionimportantmechanismCOVID-19-associatedcoagulopathycombinationmayprovevaluableidentifyingrequiringhigherintensityThromboembolicimpairedCoagulopathyD-dimersHypofibrinolysis

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