Herrmann Johannes, Notz Quirin, Schlesinger Tobias, Stumpner Jan, Kredel Markus, Sitter Magdalena, Schmid Benedikt, Kranke Peter, Schulze Harald, Meybohm Patrick, Lotz Christopher
Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
Institute of Experimental Biomedicine, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany.
Thromb J. 2021 Jun 2;19(1):39. doi: 10.1186/s12959-021-00293-8.
Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT.
This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020.
Median age was 61 years (IQR: 51-69). Median PaO/FiO on admission was 122 mmHg (IQR: 87-189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD: 3.7; 95 %CI 1.3-10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications.
Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications..
2019年冠状病毒病（COVID-19）相关凝血病（CAC）导致大量危重症COVID-19患者发生血栓栓塞事件。然而，尚未建立针对CAC的特定诊断或治疗算法。在本研究中，我们使用即时检验（POCT）分析了COVID-19诱导的急性呼吸窘迫综合征（ARDS）患者的凝血异常及其与止血并发症的关系。我们的假设是，利用POCT可以在有血栓栓塞并发症风险的COVID-19诱导的ARDS患者中识别出特定的诊断模式。
这是一项单中心回顾性观察研究。对2020年3月12日至6月30日期间连续入住ICU的18例因COVID-19诱导的ARDS患者的247次旋转血栓弹力图（Rotem®）和165次阻抗聚集图（Multiplate®）的纵向数据进行了分析。
中位年龄为61岁（四分位间距：51-69）。入院时的中位PaO/FiO为122 mmHg（四分位间距：87-189），表明为中度至重度ARDS。78%的患者发生了任何形式的止血并发症，其中39%发生深静脉/手臂血栓形成，22%发生肺栓塞，17%发生大出血。在Rotem®中，A10升高和最大血凝块硬度（MCF）表明血凝块强度更高。EXTEM A10减去FIBTEM A10的差值（ΔA10）>30 mm，描绘了血凝块硬度中仅血小板部分，与血栓栓塞事件风险较高相关（比值比：3.7；95%置信区间1.3-10.3；p=0.02）。Multiplate®聚集试验显示血小板功能低下。在重症监护病房（ICU）入院时，单个Rotem®和Multiplate®参数与血栓栓塞或出血并发症之间无相关性。
Rotem®和Multiplate®结果表明，COVID-19诱导的ARDS存在高凝状态和血小板功能低下，但总体而言与止血并发症的相关性较差。
