Hypofibrinolytic state and high thrombin generation may play a major role in SARS-COV2 associated thrombosis
Hypofibrinolytic state and high thrombin generation may play a major role in SARS-COV2 associated thrombosis
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DOI：
10.1111/jth.15016
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发表时间：
2020-08-11
影响因子：
10.4
通讯作者：
Dargaud, Yesim
中科院分区：
文献类型：
--
作者：
Nougier, Christophe;Benoit, Remi;Dargaud, Yesim
背景30%入住重症监护室的新冠肺炎患者尽管采取了血栓预防措施，但仍出现血栓并发症。卧床休息、肥胖、缺氧、凝血障碍和急性过度炎症是先前研究报告的潜在机制。更好地了解导致血栓形成的潜在机制对于制定更合适的预防和治疗策略至关重要。目的我们旨在评估78例新冠肺炎患者的纤溶活性和凝血酶生成。患者与方法48例重症监护室患者和30例内科患者纳入研究。所有患者均接受血栓预防。我们测量了纤溶参数（组织纤溶酶原激活剂、派-1、凝血酶激活的纤溶抑制剂、α 2抗纤溶酶和组织纤溶酶原激活剂修饰的ROTEM装置）、凝血酶生成和其他凝血试验（D-二聚体、纤维蛋白原、因子VIII、抗凝血酶）。结果和结论：我们观察到两个关键的发现：高凝血酶生成能力，保持在正常值范围内，尽管肝素治疗和纤溶功能减退，主要与派-1水平升高。改良的ROTEM能够同时检测新冠肺炎血栓形成患者的高凝状态和低纤溶状态。
Background Thirty percent of Covid-19 patients admitted to intensive care units present with thrombotic complications despite thromboprophylaxis. Bed rest, obesity, hypoxia, coagulopathy, and acute excessive inflammation are potential mechanisms reported by previous studies. Better understanding of the underlying mechanisms leading to thrombosis is crucial for developing more appropriate prophylaxis and treatment strategies. Objective We aimed to assess fibrinolytic activity and thrombin generation in 78 Covid-19 patients. Patients and Methods Forty-eight patients admitted to the intensive care unit and 30 patients admitted to the internal medicine department were included in the study. All patients received thromboprophylaxis. We measured fibrinolytic parameters (tissue plasminogen activator, PAI-1, thrombin activatable fibrinolysis inhibitor, alpha2 anti-plasmin, and tissue plasminogen activator-modified ROTEM device), thrombin generation, and other coagulation tests (D-dimer, fibrinogen, factor VIII, antithrombin). Results and Conclusions We observed two key findings: a high thrombin generation capacity that remained within normal values despite heparin therapy and a hypofibrinolysis mainly associated with increased PAI-1 levels. A modified ROTEM is able to detect both hypercoagulability and hypofibrinolysis simultaneously in Covid-19 patients with thrombosis.