Insights into Fibrinogen-Mediated COVID-19 Hypercoagubility in Critically Ill Patients. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Miltiades, Andrea; Houck, Philipp J.; Monteleone, Matthew; Harrison, Neil L.; Cabrera-Garcia, David; Roh, David; Wagener, Gebhard
• Is Part Of: Journal of neurosurgical anesthesiology. Volume 34:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: severe acute respiraotry syndrome coronavirus 2 -- hypercoagulability -- thromboembolic complications -- viscoelastic testing -- COVID-19 -- hypercoaguability -- fibrinolysis -- plasminogen activator inhibitor-1 (PAI-1); Anesthesia in neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 617.96748
• DOI: 10.1097/ANA.0000000000000812
• Languages: English
• ISSNs: 0898-4921

Abstract

Abstract : 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.