COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemo
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COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis Bingwen Eugene Fan1,2,9,10 · Jensen Ng3,9,10 · Stephrene Seok Wei Chan1,2,9,10 · Dheepa Christopher1,2,9,10 · Allison Ching Yee Tso1,2,9,10 · Li Min Ling4,5,9,10 · Barnaby Edward Young4,5,9,10 · Lester Jun Long Wong1 · Christina Lai Lin Sum6 · Hwee Tat Tan6 · Mui Kia Ang6 · Gek Hsiang Lim7 · Kiat Hoe Ong1,2,9,10 · Ponnudurai Kuperan1,2,9,10 · Yew Woon Chia8,9,10 Accepted: 15 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well. Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of 20 μg/ml for 2 of the patients (16.7%). Assuming that the D-dimer values for these 2 patients are at 20 μg/ml, it suggests that the mean values of the D-dimer was at least 5.7 (7.2) μg/ml (median, IQR: 2.1, 1.4–7.8 μg/ ml) in the study population. None of the patients fulfilled ISTH criteria for DIC. For quantification of clotting factors, the significant findings were that all 12 patients had elevated Factor VIII levels (median of 262.5%), approximately half (45.5%) had elevated factor IX levels, and 1 in 3 patients (33.3%) had an elevated factor II level. All 12 patients also had a markedly elevated vWF antigen level, with median value of 320% (IQR 259–371%). Anti-thrombin III levels were
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Table 1 Demographic and Clinical Characteristics of 12 ICU Patients with COVID-19
Total number of patients (N = 12) No. Age (years) Gender Male Female Ethnic group Chinese Malays Indians Others Body mass index; BMI (kg/m2) Comorbidities Hypertension Diabetes COPD Hyperlipidaemia IHD Renal impairment Onset of symptoms to hospital admission (days) Symptoms presented prior admission Symptoms presented post admission Onset of symptoms to ICU admission (days) Symptoms presented prior admission Symptoms presented post admission Day of illness at point of haemostatic assessment SOFA score on ICU admission Padua (VTE) score on ICU admission PaO2 /FiO2 on ICU admission Mechanical ventilation No Yes Length of ICU stay (days) Length of hospital stay (days) ICU mortality No Yes Hospital mortality No Yes
%
11 1
91.7 8.3
4 2 4 2
33.3 16.7 33.3 16.7
6 5 1 4 0 2
50.0 41.7 8.3 33.3 0.0 16.7
3 9
25.0 75.0
10 2
83.3 16.7
10 2
83.3 16.7
Median
IQR
52
41, 61
25.7
23, 29.3
3.5 11.5
3, 4 0, 23
8.5 – 13.5 4 5 168
8, 12 – 11.5, 18.5 2, 6 5, 6 122, 203
11.5 25
4.5, 24.5 21, 34.5
Out of the 2 deaths, 1 was due to bleeding complications
mostly normal with a median
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