Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.
J Thromb Haemost. 2020 Jul;18(7):1738-1742. doi: 10.1111/jth.14850. Epub 2020 Jun 24.
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.
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.
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.
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.
COVID-19 继发的严重炎症状态导致止血严重紊乱，最近被描述为弥漫性血管内凝血（DIC）和消耗性凝血病状态，表现为血小板计数降低、纤维蛋白（原）降解产物如 D-二聚体增加以及纤维蛋白原降低。
收集因 COVID-19 入住重症监护病房的 24 例患者的全血，使用 TEG 即时检测设备进行血栓弹力图检测，单次检测 30 例。其中 6 例连续两天重复测量，共进行 30 次观察。评估血浆其他止血参数。
TEG 参数提示存在高凝状态，表现为 K 角和 MA 值降低，而角和 MA 值升高。血小板计数正常或升高，凝血酶原时间和活化部分凝血活酶时间接近（正常）。纤维蛋白原增加，D-二聚体显著增加。C 反应蛋白升高。VIII 因子和血管性血友病因子（n=11）增加。抗凝血酶（n=11）略有减少，蛋白 C（n=11）增加。
COVID-19 患者的这一组结果与急性 DIC 不一致，而支持高凝状态和严重炎症状态共存。这些发现可能解释了一些患者中观察到的静脉血栓栓塞事件，并支持抗血栓预防/治疗。急需开展临床试验以确定药物类型、剂量和最佳预防疗程。
