Forgács Robin, Bokrétás Gergely Péter, Monori Zoltán, Molnár Zsolt, Ruszkai Zoltán
Department of Anesthesiology and Intensive Therapy, Flór Ferenc Hospital Kistarcsa, 2143 Kistarcsa, Hungary.
Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary.
Biomedicines. 2023 Sep 5;11(9):2463. doi: 10.3390/biomedicines11092463.
COVID-19-associated coagulopathy (CAC), mainly characterized by hypercoagulability leading to micro- and macrovascular thrombotic events due to the fibrinolysis shutdown phenomenon, is a life-threatening complication of severe SARS-CoV-2 infection. However, optimal criteria to assess patients with the highest risk for progression of severe CAC are still unclear. Bedside point-of-care viscoelastic testing (VET) appears to be a promising tool to recognize CAC, to support the appropriate therapeutic decisions, and to monitor the efficacy of the treatment. The ClotPro VET has the potential to reveal fibrinolysis resistance indicated by a clot lysis time (LT) > 300 s on the TPA-test. We present a case of severe SARS-CoV-2 infection complicated by CAC-resulting portal vein thrombosis (PVT) and subsequent liver failure despite therapeutic anticoagulation. Since fibrinolysis shutdown (LT > 755 s) caused PVT, we performed a targeted systemic fibrinolytic therapy. We monitored the efficacy of the treatment with repeated TPA assays every three hours, while the dose of recombinant plasminogen activator (rtPA) was adjusted until fibrinolysis shutdown completely resolved and portal vein patency was confirmed by an ultrasound examination. Our case report highlights the importance of VET-guided personalized therapeutic approach during the care of severely ill COVID-19 patients, in order to appropriately treat CAC.
新型冠状病毒肺炎相关凝血病（CAC）主要表现为高凝状态，由于纤维蛋白溶解关闭现象导致微血管和大血管血栓形成事件，是严重的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的危及生命的并发症。然而，评估严重CAC进展风险最高的患者的最佳标准仍不明确。床旁即时粘弹性检测（VET）似乎是一种有前景的工具，可用于识别CAC、支持适当的治疗决策并监测治疗效果。ClotPro VET有可能揭示在组织型纤溶酶原激活剂（TPA）试验中凝块溶解时间（LT）>300秒所表明的纤维蛋白溶解抵抗。我们报告一例严重的SARS-CoV-2感染病例，尽管进行了抗凝治疗，但仍并发CAC导致门静脉血栓形成（PVT）及随后的肝功能衰竭。由于纤维蛋白溶解关闭（LT>755秒）导致了PVT，我们进行了有针对性的全身纤溶治疗。我们每三小时重复进行TPA检测以监测治疗效果，同时调整重组纤溶酶原激活剂（rtPA）的剂量，直到纤维蛋白溶解关闭完全消除且超声检查确认门静脉通畅。我们的病例报告强调了在重症新型冠状病毒肺炎患者的治疗过程中，VET指导的个性化治疗方法对于适当治疗CAC的重要性。
