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Hypofibrinolytic state and high thrombin generation may play a major role in SARS‐COV2 associated thrombosis
Author(s) -
Nougier Christophe,
Benoit Remi,
Simon Marie,
DesmursClavel Helene,
Marcotte Guillaume,
Argaud Laurent,
David Jean Stephane,
Bonnet Aurelie,
Negrier Claude,
Dargaud Yesim
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.15016
Subject(s) - medicine , fibrinolysis , plasminogen activator , coagulopathy , thrombosis , antithrombin , fibrinogen , protein c , intensive care unit , coagulation , hemostasis , thrombin , plasmin , tissue plasminogen activator , venous thrombosis , heparin , gastroenterology , platelet , biochemistry , chemistry , enzyme
Background Thirty percent of Covid‐19 patients admitted to intensive care units present with thrombotic complications despite thromboprophylaxis. Bed rest, obesity, hypoxia, coagulopathy, and acute excessive inflammation are potential mechanisms reported by previous studies. Better understanding of the underlying mechanisms leading to thrombosis is crucial for developing more appropriate prophylaxis and treatment strategies. Objective We aimed to assess fibrinolytic activity and thrombin generation in 78 Covid‐19 patients. Patients and Methods Forty‐eight patients admitted to the intensive care unit and 30 patients admitted to the internal medicine department were included in the study. All patients received thromboprophylaxis. We measured fibrinolytic parameters (tissue plasminogen activator, PAI‐1, thrombin activatable fibrinolysis inhibitor, alpha2 anti‐plasmin, and tissue plasminogen activator‐modified ROTEM device), thrombin generation, and other coagulation tests (D‐dimer, fibrinogen, factor VIII, antithrombin). Results and Conclusions We observed two key findings: a high thrombin generation capacity that remained within normal values despite heparin therapy and a hypofibrinolysis mainly associated with increased PAI‐1 levels. A modified ROTEM is able to detect both hypercoagulability and hypofibrinolysis simultaneously in Covid‐19 patients with thrombosis.