tetano
Editor, Senior Moderator
J Neurosurg Anesthesiol
. 2022 Jan 1;34(1):136-140.
doi: 10.1097/ANA.0000000000000812.
Insights into Fibrinogen-Mediated COVID-19 Hypercoagubility in Critically Ill Patients
Andrea Miltiades[SUP] 1 [/SUP], Philipp J Houck[SUP] 1 [/SUP], Matthew Monteleone[SUP] 2 [/SUP], Neil L Harrison[SUP] 1 [/SUP], David Cabrera-Garcia[SUP] 1 [/SUP], David Roh[SUP] 3 [/SUP], Gebhard Wagener[SUP] 1 [/SUP]
Affiliations
Abstract
Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability that may cause thromobembolic complications. We describe our recent studies investigating the mechanisms of hypercoagulability in patients with severe COVID-19 requiring mechanical ventilation during the COVID-19 crisis in New York City in spring 2020. Using rotational thombelastometry we found that almost all patients with severe COVID-19 had signs of hypercoagulability compared with non-COVID-19 controls. Specifically, the maximal clot firmness in the fibrin-based extrinsically activated test was almost twice the upper limit of normal in COVID patients, indicating a fibrin-mediated cause for hypercoagulability. To better understand the mechanism of this hypercoagulability we measured the components of the fibrinolytic pathways. Fibrinogen, tissue plasminogen activator and plasminogen activator inhibitor-1, but not plasminogen levels were elevated in patients with severe COVID-19. Our studies indicate that hypercoagulability in COVID-19 may be because of decreased fibrinolysis resulting from inhibition of plasmin through high levels of plasminogen activator inhibitor-1. Clinicians creating treatment protocols for anticoagulation in critically ill COVID-19 patients should consider these potential mechanisms of hypercoaguability.
. 2022 Jan 1;34(1):136-140.
doi: 10.1097/ANA.0000000000000812.
Insights into Fibrinogen-Mediated COVID-19 Hypercoagubility in Critically Ill Patients
Andrea Miltiades[SUP] 1 [/SUP], Philipp J Houck[SUP] 1 [/SUP], Matthew Monteleone[SUP] 2 [/SUP], Neil L Harrison[SUP] 1 [/SUP], David Cabrera-Garcia[SUP] 1 [/SUP], David Roh[SUP] 3 [/SUP], Gebhard Wagener[SUP] 1 [/SUP]
Affiliations
- PMID: 34870637
- DOI: 10.1097/ANA.0000000000000812
Abstract
Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability that may cause thromobembolic complications. We describe our recent studies investigating the mechanisms of hypercoagulability in patients with severe COVID-19 requiring mechanical ventilation during the COVID-19 crisis in New York City in spring 2020. Using rotational thombelastometry we found that almost all patients with severe COVID-19 had signs of hypercoagulability compared with non-COVID-19 controls. Specifically, the maximal clot firmness in the fibrin-based extrinsically activated test was almost twice the upper limit of normal in COVID patients, indicating a fibrin-mediated cause for hypercoagulability. To better understand the mechanism of this hypercoagulability we measured the components of the fibrinolytic pathways. Fibrinogen, tissue plasminogen activator and plasminogen activator inhibitor-1, but not plasminogen levels were elevated in patients with severe COVID-19. Our studies indicate that hypercoagulability in COVID-19 may be because of decreased fibrinolysis resulting from inhibition of plasmin through high levels of plasminogen activator inhibitor-1. Clinicians creating treatment protocols for anticoagulation in critically ill COVID-19 patients should consider these potential mechanisms of hypercoaguability.