The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome.
The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome.
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DOI：
10.1111/jth.14854
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发表时间：
2020-07
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几乎没有观察到新冠肺炎急性呼吸窘迫综合征患者的促凝状态。有关血栓栓塞症并发症的报道很少，但对这一问题的临床相关性提出了建议。前瞻性观察研究的目的是用标准和粘弹性凝血试验来表征新冠肺炎急性呼吸窘迫综合征患者的凝血状态，并评估他们在建立积极的血栓预防措施后的变化。16名新冠肺炎急性呼吸窘迫综合征患者在重症监护病房入院时接受了完整的凝血指标检查。在随后的7天内，对10名患者进行了随访，在选定的病例中，增加了低分子肝素、抗凝血酶水平校正和氯吡格雷的剂量。基线时，患者表现为凝血强度增加(CS，中位数55HPA，95%四分位范围35-63)，血小板对CS的贡献(PCS，43HPA；四分位范围24-45)，纤维蛋白原对CS的贡献(FCS，12HPA；四分位范围6-13.5)，D-二聚体水平升高(5.5HPA，四分位范围2.5-6.5)，以及高纤维蛋白原血症(794 mg/dL，四分位范围583-933)。纤维蛋白原水平与白细胞介素6水平相关(R2=2.506，P=0.003)。在增加血栓预防措施后，纤维蛋白原、D-二聚体(P=0.017)、CS(P=0.013)、PCS(P=4.035)和FCS(P=0.038)水平均有明显的时间相关性下降(P<0.05)。这些患者的促凝血模式可能证明在疾病过程中血栓栓塞症并发症(肺栓塞)的临床报道是正确的。需要进一步的研究来评估这种情况的最佳预防和治疗方法。
Few observations exist with respect to the pro‐coagulant profile of patients with COVID‐19 acute respiratory distress syndrome (ARDS). Reports of thromboembolic complications are scarce but suggestive for a clinical relevance of the problem. Prospective observational study aimed to characterize the coagulation profile of COVID‐19 ARDS patients with standard and viscoelastic coagulation tests and to evaluate their changes after establishment of an aggressive thromboprophylaxis. Sixteen patients with COVID‐19 ARDS received a complete coagulation profile at the admission in the intensive care unit. Ten patients were followed in the subsequent 7 days, after increasing the dose of low molecular weight heparin, antithrombin levels correction, and clopidogrel in selected cases. At baseline, the patients showed a pro‐coagulant profile characterized by an increased clot strength (CS, median 55 hPa, 95% interquartile range 35‐63), platelet contribution to CS (PCS, 43 hPa; interquartile range 24‐45), fibrinogen contribution to CS (FCS, 12 hPa; interquartile range 6‐13.5) elevated D‐dimer levels (5.5 μg/mL, interquartile range 2.5‐6.5), and hyperfibrinogenemia (794 mg/dL, interquartile range 583‐933). Fibrinogen levels were associated (R2 = .506, P = .003) with interleukin‐6 values. After increasing the thromboprophylaxis, there was a significant (P = .001) time‐related decrease of fibrinogen levels, D‐dimers (P = .017), CS (P = .013), PCS (P = .035), and FCS (P = .038). The pro‐coagulant pattern of these patients may justify the clinical reports of thromboembolic complications (pulmonary embolism) during the course of the disease. Further studies are needed to assess the best prophylaxis and treatment of this condition.
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