Derangement of the coagulation process using subclinical markers and viscoelastic measurements in critically ill patients with coronavirus disease 2019 pneumonia and non-coronavirus disease 2019 pneumonia

• Published in: Blood coagulation & fibrinolysis Vol. 32; no. 2; p. 80
• Main Authors: Pavoni, Vittorio, Gianesello, Lara, Pazzi, Maddalena, Horton, Andrew, Suardi, Lorenzo R
• Format: Journal Article
• Language: English
• Published: England 01.03.2021
• Subjects: Aged; Aged, 80 and over; Blood Coagulation; Blood Coagulation Disorders - blood; Blood Coagulation Disorders - etiology; Blood Coagulation Tests; COVID-19 - blood; COVID-19 - complications; Critical Illness; Female; Fibrin Fibrinogen Degradation Products - analysis; Humans; Intensive Care Units; Male; Middle Aged; Platelet Count; Pneumonia - blood; Pneumonia - complications; SARS-CoV-2 - isolation & purification; Thrombelastography
• ISSN: 1473-5733
• DOI: 10.1097/MBC.0000000000000971

Systemic coagulation abnormalities including clotting activation and inhibition of anticoagulant factors have been observed in patients with pneumonia. In severe coronavirus disease 2019 (COVID-19) the alteration of coagulation parameters was associated with poor prognosis. We evaluated the difference in coagulopathy between critically ill patients with COVID-19 pneumonia (COVID group) and non-COVID-19 pneumonia (non-COVID group), using traditional coagulation markers and rotational thromboelastometry (ROTEM). Standard laboratory and ROTEM parameters were evaluated in 45 patients (20 COVID group patients and 25 non-COVID group patients) at time of admission to the Intensive Care Unit (ICU) (T0) and at 5 (T5) and 10 days (T10) later. In all evaluations times, platelet count was found higher in COVID group rather than in non-COVID group. At T0, COVID group revealed a fibrinogen value greater than non-COVID group. d-Dimer values were high in both groups and they were not statistically different. At T0 COVID group showed a significant reduction of clot formation time in INTEM and in EXTEM and a significant increase of maximum clot firmness in INTEM, EXTEM and FIBTEM respect to non-COVID group. Moreover, COVID group demonstrated a coagulability state with ROTEM profiles higher than non-COVID group at T5 and T10. Coagulation profiles showed that critically ill patients with COVID-19 pneumonia are characterized by a higher coagulable state than others; this greater procoagulative state persists over time.