Departments of Anesthesiology.
Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH.
J Neurosurg Anesthesiol. 2022 Jan 1;34(1):136-140. doi: 10.1097/ANA.0000000000000812.
Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability that may cause thromobembolic complications. We describe our recent studies investigating the mechanisms of hypercoagulability in patients with severe COVID-19 requiring mechanical ventilation during the COVID-19 crisis in New York City in spring 2020. Using rotational thombelastometry we found that almost all patients with severe COVID-19 had signs of hypercoagulability compared with non-COVID-19 controls. Specifically, the maximal clot firmness in the fibrin-based extrinsically activated test was almost twice the upper limit of normal in COVID patients, indicating a fibrin-mediated cause for hypercoagulability. To better understand the mechanism of this hypercoagulability we measured the components of the fibrinolytic pathways. Fibrinogen, tissue plasminogen activator and plasminogen activator inhibitor-1, but not plasminogen levels were elevated in patients with severe COVID-19. Our studies indicate that hypercoagulability in COVID-19 may be because of decreased fibrinolysis resulting from inhibition of plasmin through high levels of plasminogen activator inhibitor-1. Clinicians creating treatment protocols for anticoagulation in critically ill COVID-19 patients should consider these potential mechanisms of hypercoaguability.
2020 年春季，纽约市出现 COVID-19 危机时，我们开展了相关研究，旨在调查机械通气治疗的重症 COVID-19 患者发生高凝状态的机制。我们采用旋转血栓弹力描记法发现，与非 COVID-19 对照组相比，几乎所有重症 COVID-19 患者均存在高凝状态的迹象。具体而言，基于纤维蛋白的外在激活试验中最大血凝块硬度几乎是 COVID 患者正常上限的两倍，表明高凝状态的发生与纤维蛋白有关。为了更好地了解这种高凝状态的发生机制，我们测量了纤维蛋白溶解途径的各个组分。重症 COVID-19 患者的纤维蛋白原、组织型纤溶酶原激活物和纤溶酶原激活物抑制剂-1 水平升高，而纤溶酶原水平正常。我们的研究表明，COVID-19 中的高凝状态可能是由于纤溶酶原激活物抑制剂-1 水平升高导致纤溶作用受到抑制，从而引起纤溶活性降低所致。为危重症 COVID-19 患者制定抗凝治疗方案的临床医生应考虑这些潜在的高凝状态发生机制。
