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. 2020 Jul;18(7):1738-1742.
doi: 10.1111/jth.14850. Epub 2020 Jun 24.

Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis

Mauro Panigada  1 , Nicola Bottino  1 , Paola Tagliabue  1 , Giacomo Grasselli  2 , Cristina Novembrino  3 , Veena Chantarangkul  3 , Antonio Pesenti  1   2 , Flora Peyvandi  2   3 , Armando Tripodi  3
Affiliations

Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis

Mauro Panigada et al. J Thromb Haemost. 2020 Jul.

Abstract

Background: The severe inflammatory state secondary to COVID-19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D-dimer, as well as low fibrinogen.

Aims: Whole blood from 24 patients admitted at the intensive care unit because of COVID-19 was collected and evaluated with thromboelastography by the TEG point-of-care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis.

Results: TEG parameters are consistent with a state of hypercoagulability as shown by decreased values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal). Fibrinogen was increased and D-dimer was dramatically increased. C-reactive protein was increased. Factor VIII and von Willebrand factor (n = 11) were increased. Antithrombin (n = 11) was marginally decreased and protein C (n = 11) was increased.

Conclusion: The results of this cohort of patients with COVID-19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/treatment. Clinical trials are urgently needed to establish the type of drug, dosage, and optimal duration of prophylaxis.

Keywords: factor VIII; hypercoagulability; protein C; protein S; sepsis; von Willebrand factor.

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Figures

Figure 1
Figure 1
Result distribution of the maximal clot amplitude (MA) in the patient population. bell‐shaped and vertical lines represent the univariate density estimation and the limits of the reference range, respectively
Figure 2
Figure 2
Typical TEG tracings. Upper and lower lines represent a healthy subject and a COVID‐19 patient, respectively. The COVID‐19 patient was characterized by the following TEG parameters: R = 5.5 minutes. K = 0.9 minutes. Angle K = 78.8°. MA = 88.8 mm and by the following hemostasis parameters: Prothrombin time ratio = 1.19. Activated partial thromboplastin time ratio = 1.21. D‐dimer = 1829 ng/mL. Fibrinogen = 849 mg/dL. Antithrombin = 87 U/dL; Protein C = 116 U/dL. Protein S (free antigen) = 68 U/dL. Factor VIII = 269 U/dL. von Willebrand factor (antigen) = 476 U/dL. von Willebrand factor (ristocetin cofactor) = 347 U/dL. Platelet count = 546 × 109/L
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