tetano
Editor, Senior Moderator
Crit Care Explor
. 2020 Dec 17;2(12):e0308.
doi: 10.1097/CCE.0000000000000308. eCollection 2020 Dec.
Thromboembolism, Hypercoagulopathy, and Antiphospholipid Antibodies in Critically Ill Coronavirus Disease 2019 Patients: A Before and After Study of Enhanced Anticoagulation
Jan van der Linden[SUP] 1 2 [/SUP], Lou Almskog[SUP] 1 2 [/SUP], Andreas Liliequist[SUP] 1 3 [/SUP], Jonathan Grip[SUP] 1 4 [/SUP], Thomas Fux[SUP] 1 2 [/SUP], Susanne Rysz[SUP] 1 3 [/SUP], Anna ?gren[SUP] 5 [/SUP], Anders Oldner[SUP] 1 6 [/SUP], Marcus St?hlberg[SUP] 3 7 [/SUP]
Affiliations
Abstract
To determine the prevalence of thrombotic events, functional coagulation tests, inflammatory biomarkers, and antiphospholipid antibodies before and after enhanced anticoagulation in critically ill coronavirus disease 2019 patients.
Design: Retrospective.
Setting: Tertiary intensive care unit.
Patients: Two cross-sectional cohorts of ICU-treated coronavirus disease 2019 patients were included before (cohort 1, n = 12) and after (cohort 2, n = 14) enhanced prophylactic anticoagulation strategy.
Interventions: Before and after study of enhanced anticoagulation.
Measurements and main results: Thromboelastometry point-of-care coagulation tests were performed by thromboelastography (Tem International GmbH, Munich, Germany), standard blood tests were extracted from patient charts, and presence of antiphospholipid antibodies in plasma was measured. All patients were males on mechanical ventilation. In cohort 1 (low-molecular-weight heparin dose: 129 ? 53 U/kg/24 hr), 50% had pulmonary embolism, and thromboelastography analysis revealed hypercoagulation in a majority of patients and greater than 80% had detectable antiphospholipid antibodies. In the second cohort (enhanced low-molecular-weight heparin dose: 200 ? 82 U/kg/24 hr; p = 0.04 vs cohort 1), we found a nonsignificantly lower prevalence of pulmonary embolism (21%; p = 0.22), lower fibrinogen (6.3 ? 2.5 vs 8.7 ? 2.0; p = 0.02), reduced fibrinogen-dependent thromboelastography (p < 0.001), and lower inflammatory markers.
Conclusions: In these two cross-sectional cohorts of ICU-treated coronavirus disease 2019 patients, thromboembolic complications, hypercoagulation, and antiphospholipid antibodies were common. A more aggressive anticoagulation regime was associated with a reduction in inflammatory biomarkers including plasma fibrinogen and a reduction in fibrinogen-dependent hypercoagulation, as indicated by thromboelastography analyses.
Keywords: coagulopathy; coronavirus disease 2019; thrombosis.
. 2020 Dec 17;2(12):e0308.
doi: 10.1097/CCE.0000000000000308. eCollection 2020 Dec.
Thromboembolism, Hypercoagulopathy, and Antiphospholipid Antibodies in Critically Ill Coronavirus Disease 2019 Patients: A Before and After Study of Enhanced Anticoagulation
Jan van der Linden[SUP] 1 2 [/SUP], Lou Almskog[SUP] 1 2 [/SUP], Andreas Liliequist[SUP] 1 3 [/SUP], Jonathan Grip[SUP] 1 4 [/SUP], Thomas Fux[SUP] 1 2 [/SUP], Susanne Rysz[SUP] 1 3 [/SUP], Anna ?gren[SUP] 5 [/SUP], Anders Oldner[SUP] 1 6 [/SUP], Marcus St?hlberg[SUP] 3 7 [/SUP]
Affiliations
- PMID: 33364605
- PMCID: PMC7752689
- DOI: 10.1097/CCE.0000000000000308
Abstract
To determine the prevalence of thrombotic events, functional coagulation tests, inflammatory biomarkers, and antiphospholipid antibodies before and after enhanced anticoagulation in critically ill coronavirus disease 2019 patients.
Design: Retrospective.
Setting: Tertiary intensive care unit.
Patients: Two cross-sectional cohorts of ICU-treated coronavirus disease 2019 patients were included before (cohort 1, n = 12) and after (cohort 2, n = 14) enhanced prophylactic anticoagulation strategy.
Interventions: Before and after study of enhanced anticoagulation.
Measurements and main results: Thromboelastometry point-of-care coagulation tests were performed by thromboelastography (Tem International GmbH, Munich, Germany), standard blood tests were extracted from patient charts, and presence of antiphospholipid antibodies in plasma was measured. All patients were males on mechanical ventilation. In cohort 1 (low-molecular-weight heparin dose: 129 ? 53 U/kg/24 hr), 50% had pulmonary embolism, and thromboelastography analysis revealed hypercoagulation in a majority of patients and greater than 80% had detectable antiphospholipid antibodies. In the second cohort (enhanced low-molecular-weight heparin dose: 200 ? 82 U/kg/24 hr; p = 0.04 vs cohort 1), we found a nonsignificantly lower prevalence of pulmonary embolism (21%; p = 0.22), lower fibrinogen (6.3 ? 2.5 vs 8.7 ? 2.0; p = 0.02), reduced fibrinogen-dependent thromboelastography (p < 0.001), and lower inflammatory markers.
Conclusions: In these two cross-sectional cohorts of ICU-treated coronavirus disease 2019 patients, thromboembolic complications, hypercoagulation, and antiphospholipid antibodies were common. A more aggressive anticoagulation regime was associated with a reduction in inflammatory biomarkers including plasma fibrinogen and a reduction in fibrinogen-dependent hypercoagulation, as indicated by thromboelastography analyses.
Keywords: coagulopathy; coronavirus disease 2019; thrombosis.