Abstract
Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well. Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of <300 mmHg. Laboratory tests were performed for parameters of haemostasis, clot waveform analysis and anti-phospholipid antibodies. CWA parameters were raised with elevated aPTT median Min1 (clot velocity) 9.3%/s (IQR 7.1-9.9%/s), elevated PT median Min1 10.3%/s (IQR 7.1-11.1%/s), elevated aPTT median Min2 (clot acceleration) 1.5%/s 2 (IQR 1.0-1.6%/s 2 ), elevated PT median Min2 5.2%/s 2 (3.6-5.7%/s 2 ), elevated aPTT median Max2 (clot deceleration) 1.3%/s 2 (IQR 0.8-1.4%/s 2 ) elevated PT median Max2 3.8%/s 2 (IQR 2.6-4.2%/s 2 ), increased aPTT median Delta change (decreased light transmission due to increased clot formation) 87.8% (IQR 70.2-91.8%) and PT median Delta change 33.0%. This together with raised median Factor VIII levels of 262.5%, hyperfibrinogenemia (median fibrinogen levels 7.5 g/L), increased median von Willebrand factor antigen levels 320% and elevated median D-dimer levels 1.7 μg/dl support the diagnosis of COVID-19 associated coagulopathy. A lupus anticoagulant was present in 50% of patients. Our laboratory findings further support the view that severe SARS-CoV-2 infection is associated with a state of hypercoagulability.
Keywords: Coronavirus; Hypercoagulability; Sepsis; Thrombophilia; Thrombosis.
【저자키워드】 coronavirus, Sepsis, Thrombophilia, hypercoagulability, thrombosis., 【초록키워드】 COVID-19, antibodies, severe COVID-19, mechanical ventilation, Infection, intensive care unit, Delta, risk, oxygen, Transmission, ICU, Laboratory, Antigen, Coagulopathy, Patient, von Willebrand factor, haemostasis, patients, Anticoagulant, factor VIII, D-dimer level, Analysis, Laboratory test, Support, Critically ill patient, Microvascular thrombosis, syndrome, PaO2/FiO2 ratio, parameter, venous, severe SARS-CoV-2, performed, raised, elevated, was collected, median, consumptive, diagnosis of COVID-19, fibrinogen level, IQR, the SARS-CoV-2, with COVID-19, 【제목키워드】 COVID-19, Coagulopathy, Critically ill, haemostasis, Analysis, hypercoagulable, parameter, demonstrated,