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

Critical Care

Annika Kurreck¹  Abakar Magomedov²  Inka Gotthardt³  Daniel Zickler³  Frédéric H. Münch³  Roland Koerner³  Kai-Uwe Eckardt³  Jan Matthias Kruse³  Andreas Kahl³  Thomas Dörner⁴  Julian Kamhieh-Milz⁵  Sophie K. Piper⁶ 

[1] Department of Hematology and Oncology, Charité – Universitätsmedizin Berlin;Department of Hepatology and Gastroenterology, Charité – Universitätsmedizin Berlin;Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin;Department of Rheumatology Und Clinical Immunology, Charité – Universitätsmedizin Berlin;Institute for Transfusion Medicine, Charité – Universitätsmedizin Berlin;Institute of Biometry and Clinical Epidemiology, Charité – Universitätmedizin Berlin;

关键词: COVID-19;    Coagulopathy;    Hypofibrinolysis;    ROTEM;    D-dimers;   

DOI  :  10.1186/s13054-020-03401-8

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown