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The procoagulant pattern of patients with COVID‐19 acute respiratory distress syndrome
Author(s) -
Ranucci Marco,
Ballotta Andrea,
Di Dedda Umberto,
Baryshnikova Ekaterina,
Dei Poli Marco,
Resta Marco,
Falco Mara,
Albano Giovanni,
Menicanti Lorenzo
Publication year - 2020
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.14854
Subject(s) - interquartile range , medicine , ards , pulmonary embolism , fibrinogen , fibrinolysis , intensive care unit , coagulation , thrombosis , gastroenterology , lung
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 ( R 2 = .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.