Thromb Haemost
DOI: 10.1055/s-0040-1710018
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure

Luca Spiezia
1  General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Annalisa Boscolo
2  Anaesthesia and Intensive Care Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Francesco Poletto
1  General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Lorenzo Cerruti
1  General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Ivo Tiberio
3  Intensive Care Central Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Elena Campello
1  General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Paolo Navalesi
2  Anaesthesia and Intensive Care Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Paolo Simioni
1  General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
› Author Affiliations
Further Information

Publication History

02 April 2020

04 April 2020

Publication Date:
21 April 2020 (online)

Abstract

In late December 2019 an outbreak of a novel coronavirus (SARS-CoV-2) causing severe pneumonia (COVID-19) was reported in Wuhan, Hubei Province, China. A common finding in most COVID-19 patients is high D-dimer levels which are associated with a worse prognosis. We aimed to evaluate coagulation abnormalities via traditional tests and whole blood thromboelastometry profiles in a group of 22 (mean age 67 ± 8 years, M:F 20:2) consecutive patients admitted to the Intensive Care Unit of Padova University Hospital for acute respiratory failure due to COVID-19. Cases showed significantly higher fibrinogen and D-dimer plasma levels versus healthy controls (p < 0.0001 in both comparisons). Interestingly enough, markedly hypercoagulable thromboelastometry profiles were observed in COVID-19 patients, as reflected by shorter Clot Formation Time (CFT) in INTEM (p = 0.0002) and EXTEM (p = 0.01) and higher Maximum Clot Firmness (MCF) in INTEM, EXTEM and FIBTEM (p < 0.001 in all comparisons). In conclusion, COVID-19 patients with acute respiratory failure present a severe hypercoagulability rather than consumptive coagulopathy. Fibrin formation and polymerization may predispose to thrombosis and correlate with a worse outcome.

Authors' Contributions

L.S. and A.B. study design, data analysis, and drafting; A.B., F.P., L.C., and I.T. patient enrolment; L.S. and E.C. performed laboratory tests; P.N. and P.S. study supervision and final approval.