Abstract - Text

Offenlegung Interessenkonflikt:

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Methods

A total of 23 consecutive patients with COVID-19 infection were included in the study. 14 patients, who were admitted to ICU because of acute respiratory syndromes and 9 were from non-ICU department. Citrated blood samples were collected and investigated using a new thrombelastography technique (ClotPro Enicor Germany). PLT counts, aPTT, PT, D-Dimer and fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and α2-antiplasmin were determined.

Invited talks abstract/summary

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Results

None of the 23 patient revealed signs of DIC (PLT:median: 258 x109/µl [range:60-501], D-Dimer:median 5.1µg/mL [range:0.85-51], fibrinogen: median: 258g/dl [range:200-900]). A reduction in the maximal clot lysis (ML%) after TPA-assay induction was observed in 6/13 ICU of whom two showed a complete fibrinolysis shut-down. Thrombelastography (TPA-Test) revealed significantly higher area under the curve (AUC) in Covid-19 patients ([mean±SD] 7.1±0.4 versus 10±1.28; p=0.0468). Maximal lysis time [LT%] revealed also significant prolongation between donors and ICU patients ([mean±SD] 193.2±16.3 versus 354.7±39.3; p=0.0014). Antifibrinolytic factors like PAI-1 (median: 2.6U/mL [range: 0-16.5]) and Plasmin-inhibitor (median:106% [range:59-148]) show high potential of antifibrinolytic status in these patients.

Background

COVID-19 is a severe acute respiratory syndrome caused by coronavirus 2 (SARS- CoV-2). Autopsies revealed high incidence of thromboembolic complications with significant microthrombi in different organs. The coagulation testing does not indicate typical signs of acute disseminated intravascular coagulation (DIC), but rather support chronic hypercoagulability together with a severe inflammatory state. 

Conclusion

Thrombelastography offers a method for prediction of fibrinolytic shut-down in these patients and support the need for early therapeutic anticoagulation to address the underestimated thromboembolic complications in these patients.