Fibrinolysis Shutdown and Thrombosis in a COVID-19 ICU.
Fibrinolysis Shutdown and Thrombosis in a COVID-19 ICU.
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DOI：
10.1097/shk.0000000000001635
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发表时间：
2021-03-01
期刊：
影响因子：
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通讯作者：
Sniecinski R
中科院分区：
文献类型：
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作者：
Creel-Bulos C;Auld SC;Caridi-Scheible M;Barker NA;Friend S;Gaddh M;Kempton CL;Maier CL;Nahab F;Sniecinski R
冠状病毒病（COVID-19）大流行已威胁到全球数百万人的生命，导致严重的全身炎症、器官功能障碍和血栓栓塞性疾病。在我们的机构内，许多重症COVID-19阳性患者发生了重大血栓形成事件，促使我们的临床医生在传统凝血测试之外评估高凝状态。我们通过旋转血栓弹性测定法（ROTEM，Instrumentation Laboratories，贝德福德，马萨诸塞州）测定了入住重症监护室的患者在3周内纤维蛋白溶解停止的患病率。在25例进行ROTEM试验的患者中，我们发现11例（44%）符合纤溶停止标准。8/9例（73%）VTE患者符合纤溶停止标准。鉴于这些患者的纤溶停止率很高，我们的数据支持使用粘弹性测试来评估纤溶受损的存在。这可能有助于识别可能受益于纤溶药物给药的患者亚群。
The coronavirus disease (COVID-19) pandemic has threatened millions of lives worldwide with severe systemic inflammation, organ dysfunction, and thromboembolic disease. Within our institution, many critically ill COVID-19-positive patients suffered major thrombotic events, prompting our clinicians to evaluate hypercoagulability outside of traditional coagulation testing. We determined the prevalence of fibrinolysis shutdown via rotational thromboelastometry (ROTEM, Instrumentation Laboratories, Bedford, Mass) in patients admitted to the intensive care unit over a period of 3 weeks. In 25 patients who had a ROTEM test, we found that 11 (44%) met criteria for fibrinolysis shutdown. Eight of 9 (73%) of the VTE patients met criteria for fibrinolysis shutdown. Given the high rate of fibrinolysis shutdown in these patients, our data support using viscoelastic testing to evaluate for the presence of impaired fibrinolysis. This may help identify patient subsets who might benefit from the administration of fibrinolytics.