J Thromb Thrombolysis . COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis

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J Thromb Thrombolysis


. 2020 Oct 24.
doi: 10.1007/s11239-020-02318-x. Online ahead of print.
COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis


Bingwen Eugene Fan ^{1 2 3 4} , Jensen Ng ^{5 6 7} , Stephrene Seok Wei Chan ^{8 9 6 7} , Dheepa Christopher ^{8 9 6 7} , Allison Ching Yee Tso ^{8 9 6 7} , Li Min Ling ^{10 11 6 7} , Barnaby Edward Young ^{10 11 6 7} , Lester Jun Long Wong ⁸ , Christina Lai Lin Sum ¹² , Hwee Tat Tan ¹² , Mui Kia Ang ¹² , Gek Hsiang Lim ¹³ , Kiat Hoe Ong ^{8 9 6 7} , Ponnudurai Kuperan ^{8 9 6 7} , Yew Woon Chia ^{14 6 7}



Affiliations

• PMID: 33098540
• DOI: 10.1007/s11239-020-02318-x

Abstract

Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well. Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of <300 mmHg. Laboratory tests were performed for parameters of haemostasis, clot waveform analysis and anti-phospholipid antibodies. CWA parameters were raised with elevated aPTT median Min1 (clot velocity) 9.3%/s (IQR 7.1-9.9%/s), elevated PT median Min1 10.3%/s (IQR 7.1-11.1%/s), elevated aPTT median Min2 (clot acceleration) 1.5%/s² (IQR 1.0-1.6%/s²), elevated PT median Min2 5.2%/s² (3.6-5.7%/s²), elevated aPTT median Max2 (clot deceleration) 1.3%/s² (IQR 0.8-1.4%/s²) elevated PT median Max2 3.8%/s² (IQR 2.6-4.2%/s²), increased aPTT median Delta change (decreased light transmission due to increased clot formation) 87.8% (IQR 70.2-91.8%) and PT median Delta change 33.0%. This together with raised median Factor VIII levels of 262.5%, hyperfibrinogenemia (median fibrinogen levels 7.5 g/L), increased median von Willebrand factor antigen levels 320% and elevated median D-dimer levels 1.7 μg/dl support the diagnosis of COVID-19 associated coagulopathy. A lupus anticoagulant was present in 50% of patients. Our laboratory findings further support the view that severe SARS-CoV-2 infection is associated with a state of hypercoagulability.

Keywords: Coronavirus; Hypercoagulability; Sepsis; Thrombophilia; Thrombosis.