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. 2020 Dec 15;15(12):e0243604.
doi: 10.1371/journal.pone.0243604. eCollection 2020.

Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study

Thiago Domingos Corrêa  1 , Ricardo Luiz Cordioli  1 , João Carlos Campos Guerra  2 , Bruno Caldin da Silva  1 , Roseny Dos Reis Rodrigues  1 , Guilherme Martins de Souza  1 , Thais Dias Midega  1 , Niklas Söderberg Campos  1 , Bárbara Vieira Carneiro  1 , Flávia Nunes Dias Campos  1 , Hélio Penna Guimarães  1 , Gustavo Faissol Janot de Matos  1 , Valdir Fernandes de Aranda  2 , Leonardo José Rolim Ferraz  1
Affiliations

Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study

Thiago Domingos Corrêa et al. PLoS One. .

Abstract

Background: Coagulation abnormalities in COVID-19 patients have not been addressed in depth.

Objective: To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19.

Methods: Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10.

Results: Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM-FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C ​​than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability.

Conclusion: COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Coagulation profile accordingly to rotational thromboelastometry (ROTEM).
White filled bars represent normal coagulation profile, grey filled bars represent a hypercoagulability state and black filled bars represent a hypocoagulability state. P values comparing group SOFA>10 vs. group SOFA ≤10 at each time point were calculated with the use of Fisher's exact test.
Fig 2
Fig 2. Fibrinolysis and endogenous inhibitors of coagulation.
See this image and copyright information in PMC

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