Higher procoagulatory potential but lower DIC score in COVID-19 ARDS patients compared to non-COVID-19 ARDS patients. Issue 196 (December 2020)

• Record Type: Journal Article
• Authors: Hoechter, D.J.; Becker-Pennrich, A.; Langrehr, J.; Bruegel, M.; Zwissler, B.; Schaefer, S.; Spannagl, M.; Hinske, L.C.; Zoller, M.
• Is Part Of: Thrombosis research. Issue 196(2020)
• Page Start: 186
• Page End: 192
• Publication Date: 2020-12
• Subjects: aPTT activated partial thromboplastin time -- ARDS acute respiratory distress syndrome -- BMI body mass index -- CFT clot formation time -- COVID-19 coronavirus disease 19 -- CRP C-reactive protein -- CT clotting time -- DIC disseminated intravascular coagulation -- ECMO extracorporeal membrane oxygenation -- FEU fibrinogen equivalent units -- GGT gamma-glutamyl-transferase -- GOT glutamate-oxaloacetate-transaminase -- GPT glutamate-pyruvate-transaminase -- ICU intensive care unit -- IL-6 interleukin 6 -- INR international normalized ratio -- MCF maximum clot firmness -- ML maximum lysis -- PCT procalcitonin -- SOFA sequential organ failure assessment -- TT20 Time-to-Twenty -- VWF von-Willebrand-Factor; Anaesthesia and Intensive Care (4) -- Acute respiratory distress syndrome (ARDS) (4.01) -- Intensive Care (4.24) -- SARS-CoV-2; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.08.030
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: COVID-19 is a novel viral disease. Severe courses may present as ARDS. Several publications report a high incidence of coagulation abnormalities in these patients. We aimed to compare coagulation and inflammation parameters in patients with ARDS due to SARS-CoV-2 infection versus patients with ARDS due to other causes. Methods: This retrospective study included intubated patients admitted with the diagnosis of ARDS to the ICU at Munich university hospital. 22 patients had confirmed SARS-CoV2-infection (COVID-19 group), 14 patients had bacterial or other viral pneumonia (control group). Demographic, clinical parameters and laboratory tests including coagulation parameters and thromboelastometry were analysed. Results: No differences were found in gender ratios, BMI, Horovitz quotients and haemoglobin values. The median SOFA score, serum lactate levels, renal function parameters (creatinine, urea) and all inflammation markers (IL-6, PCT, CRP) were lower in the COVID-19 group (all: p < 0.05). INR (p < 0.001) and antithrombin (p < 0.001) were higher in COVID-19 patients. D-dimer levels (p = 0.004) and consecutively the DIC score (p = 0.003) were lower in this group. In ExTEM®, Time-to-Twenty (TT20) was shorter in the COVID-19 group (p = 0.047), these patients also had higher FibTEM® MCF (p = 0.005). Further, these patients presented with elevated antigen and activity levels of von-Willebrand-Factor (VWF). Conclusion: COVID-19 patients presented with higher coagulatory potential (shortened global clotting tests, increased viscoelastic and VWF parameters), while DIC scores were lower. An intensified anticoagulation regimen based on an individual risk assessment is advisable to avoid thromboembolic complications. Highlights: COVID-19 patients presented with higher coagulatory potential than non-COVID-ARDS. DIC scores were lower in COVID-19 ARDS patients. An intensified anticoagulation regimen might be advisable. Use of platelet inhibitors may be considered.