Procoagulation, hypercoagulation and fibrinolytic "shut down" detected with ClotPro® viscoelastic tests in COVID-19 patients
Procoagulation, hypercoagulation and fibrinolytic "shut down" detected with ClotPro® viscoelastic tests in COVID-19 patients
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DOI：
10.1556/650.2020.31870
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发表时间：
2020-05-01
期刊：
影响因子：
0.6
通讯作者：
Fazakas Janos
中科院分区：
文献类型：
--
作者：
Zatroch Istvan;Smudla Aniko;Fazakas Janos
简介：国际数据表明，超过30%的COVID-19住院患者发生动脉、静脉和微血管血栓形成或弥散性血管内凝血。这种情况的特点是高水平的D-二聚体和纤维蛋白原，延长凝血酶原时间和活化部分凝血活酶time.Method：血液样本从三个COVID-19患者在匈牙利重症监护室治疗收集和分析与ClotPro（R）测试。进行了EX试验、IN试验、FIB试验、RVV试验和TPA试验。结果：用ClotPro（R）发现了促凝、高凝和纤溶或纤溶过程的“关闭”现象。ClotPro（R）参数与常规凝血试验一致，符合非显性弥散性血管内凝血的标准。结论：这些发现鼓励进一步研究，以阐明COVID-19患者血栓栓塞事件的潜在病理生理学，并可能支持在有或无抗血小板治疗的情况下引入全剂量抗凝治疗。干预性临床试验可能有助于确定适当的药物、给药算法和最佳治疗持续时间。目前，一项试图回答这些问题的临床试验的授权正在进行中。
Introduction: International data indicate that arterial, venous and microvascular thrombosis or disseminated intravascular coagulation occur in more than 30% of hospitalized patients with COVID-19. This condition is characterized by high levels of D-dimer and fibrinogen, prolonged prothrombin time and activated partial thromboplastin time.Method: Blood samples from three COVID-19 patients treated in a Hungarian intensive care unit were collected and analyzed with ClotPro (R) tests. EX-tests, IN-test, FIB-tests, RVV-tests, and TPA-tests were performed. The results were interpreted with respect to the clinical condition of the patients.Results: Procoagulation, hypercoagulation and either fibrinolysis or a "shut down" phenomenon of the fibrinolytic process were found with ClotPro (R). The ClotPro (R) parameters were consistent with the conventional coagulation tests and corresponded with the criteria of non-overt disseminated intravascular coagulation.Conclusion: These findings encourage further investigations to elucidate the underlying pathophysiology of thromboembolic events in COVID-19 patients and may support the introduction of full dose anticoagulation with or without antiplatelet therapy. Interventional clinical trials may be helpful in defining the appropriate drug(s), for this purpose, the algorithms of administration, and the optimal duration of therapy. At present, the authorization of a clinical trial that attempts to answer these questions is in progress.