Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China.
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China.
J Thromb Thrombolysis. 2020 Oct;50(3):580-586. doi: 10.1007/s11239-020-02182-9.
The outbreak of novel coronavirus disease 2019 (COVID-19) has now become a global pandemic. Coagulopathy has been reported widely in critically ill COVID-19 patients and was related to high mortality. However, the comprehensive coagulation profiles have not been examined and the underlying mechanism of the coagulopathy in COVID-19 patients is unclear. To study the coagulation profiles of routine hemostasis tests, natural anticoagulants, coagulant factors and antiphospholipid antibodies in critically ill COVID-19 patients. This single-center and cross-section study included 19 patients with COVID-19, who were admitted to intensive care unit (ICU) at Tongji hospital in Wuhan, China, from Feb 23 to Mar 3, 2020. Demographic data, laboratory parameters, treatments and clinical outcomes of the patients were collected and analyzed. The final date of follow-up was Mar 31, 2020. In this study, 12 thrombotic events occurred in 9 patients, including 4 cerebral infarctions, 7 acro-ischemia and 1 internal jugular vein thrombosis. The common abnormalities of routine coagulation tests included evelated D-Dimer level (100%), prolonged prothrombin time (73.7%) and hyperfibrinogenemia (73.7%). The median activities of natural anticoagulants including protein C, protein S and antithrombin were all below the normal range. Factor VIII activities were significantly above normal range (median value 307%, IQR 198-441) in all patients. Factor V and factor VII activities were significantly lower in near-terminal stage patients. Anti-phospholipid antibodies were present in 10 patients. Strikingly, 4 cerebral infarction events were in patients had anti-phospholipid antibodies of multiple isotypes. Sustained hypercoagulable status and thrombotic events were common in critically ill patients with COVID-19. The low activities of natural anticoagulants, elevated factor VIII level and the presence of antiphospholipid antibodies, together, may contribute to the etiopathology of coagulopathy in COVID-19 patients.
2019 年新型冠状病毒病（COVID-19）的爆发现已成为全球大流行。危重症 COVID-19 患者广泛存在凝血功能障碍，并与高死亡率相关。然而，尚未全面检查综合凝血谱，COVID-19 患者凝血功能障碍的潜在机制尚不清楚。本单中心、横断面研究纳入了 2020 年 2 月 23 日至 3 月 3 日期间在中国武汉同济医院重症监护病房（ICU）住院的 19 例 COVID-19 患者。收集并分析患者的人口统计学数据、实验室参数、治疗方法和临床结局。随访的最终日期为 2020 年 3 月 31 日。本研究中，9 例患者发生 12 例血栓事件，包括 4 例脑梗死、7 例肢端缺血和 1 例颈内静脉血栓形成。常规凝血检测常见异常包括 D-二聚体水平升高（100%）、凝血酶原时间延长（73.7%）和纤维蛋白原血症（73.7%）。所有患者的天然抗凝剂蛋白 C、蛋白 S 和抗凝血酶的活性均低于正常范围。VIII 因子的活性均显著高于正常范围（中位数 307%，IQR 198-441）。在疾病终末期患者中，因子 V 和因子 VII 的活性显著降低。10 例患者存在抗磷脂抗体。值得注意的是，4 例脑梗死事件发生在存在多种同种型抗磷脂抗体的患者中。COVID-19 危重症患者中持续存在高凝状态和血栓事件较为常见。低水平的天然抗凝剂、VIII 因子水平升高和抗磷脂抗体的存在，可能共同导致 COVID-19 患者凝血功能障碍的发病机制。
