Procoagulatio, hypercoagulatio és fibrinolysis „shut down” kimutatása ClotPro® viszkoelasztikus tesztek segítségével COVID–19-betegekben.

Zátroch, István; Smudla, Anikó; Babik, Barna; Tánczos, Krisztián; Kopper, László; Zsuzsanna, Szabó; Fazakas, János

doi:10.1556/650.2020.31870

Cited by 19 publications

(25 citation statements)

References 9 publications

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“…36,37 The elevated D-dimer levels in combination with the elevated fibrinogen concentrations and the results of the viscoelastic analysis may indicate a greater fibrinolysis resistance, an interpretation that is consistent with recently published research. 30,38 These alterations could contribute to the observed laboratory changes consistent with disseminated intravascular coagulation, but distinctively lead to thromboembolic events in these patients.…”

Section: Discussionmentioning

confidence: 95%

Greater Fibrinolysis Resistance but No Greater Platelet Aggregation in Critically Ill COVID-19 Patients

et al. 2021

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Background The hemostatic balance in patients with coronavirus disease 2019 (COVID-19) seems to be shifted toward a hypercoagulable state. The aim of the current study was to assess the associated coagulation alterations by point-of-care-diagnostics, focusing on details of clot formation and lysis in these severely affected patients. Methods The authors’ prospective monocentric observational study included critically ill patients diagnosed with COVID-19. Demographics and biochemical data were recorded. To assess the comprehensive hemostatic profile of this patient population, aggregometric (Multiplate) and viscoelastometric (CloPro) measures were performed in the intensive care unit of a university hospital at a single occasion. Coagulation analysis and assessment of coagulation factors were performed. Data were compared to healthy controls. Results In total, 27 patients (21 male; mean age, 60 yr) were included. Impedance aggregometry displayed no greater platelet aggregability in COVID-19 in comparison with healthy controls (area under the curve [AUC] in adenosine diphosphate test, 68 ± 37 U vs. 91 ± 29 U [−27 (Hodges–Lehmann 95% CI, −48 to −1); P = 0.043]; AUC in arachidonic acid test, 102 ± 54 U vs. 115 ± 26 U [−21 (Hodges–Lehmann 95% CI, −51 to 21); P = 0.374]; AUC in thrombin receptor activating peptide 6 test, 114 ± 61 U vs. 144 ± 31 U [−31 (Hodges–Lehmann 95% CI, −69 to −7); P = 0.113]). Comparing the thromboelastometric results of COVID-19 patients to healthy controls, the authors observed significant differences in maximum clot firmness in fibrin contribution to maximum clot firmness assay (37 ± 11 mm vs. 15 ± 4 mm [21 (Hodges–Lehmann 95% CI, 17 to 26); P < 0.001]) and lysis time in extrinsic activation and activation of fibrinolysis by tissue plasminogen activator assay (530 ± 327 s vs. 211 ± 80 s [238 (Hodges–Lehmann 95% CI, 160 to 326); P < 0.001]). Conclusions Thromboelastometry in COVID-19 patients revealed greater fibrinolysis resistance. The authors did not find a greater platelet aggregability based on impedance aggregometric tests. These findings may contribute to our understanding of the hypercoagulable state of critically ill patients with COVID-19. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Discussionmentioning

confidence: 95%

Greater Fibrinolysis Resistance but No Greater Platelet Aggregation in Critically Ill COVID-19 Patients

et al. 2021

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“…SARS-CoV2-related coagulopathy is responsible for various thrombotic events linked to mortality. Described as a fibrinolytic "shut-down, " SARS-CoV2 infection promotes a pro and hypercoagulable states resulting in disseminated (intravascular coagulation (DIC), microthrombi and other venous and arterial thrombotic phenomena (4,(120)(121)(122). D-dimer and fibrinogen are both recognized as important biomarkers of the severity of coagulopathy in patients with SARS-CoV 2 infection (123,124).…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

2020

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Corona virus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is recognized as a global pandemic by WHO 2020 with 5,934 936 infections, 367,166 deaths and affecting over 200 countries as of 30th May 2020. Acute Ischemic Stroke (AIS) in brain is also emerging as an important neurovascular/neurological complication of COVID-19, associated with extreme immune responses leading to dysregulated coagulation system and generalized thrombo-embolic status and increased risk of AIS especially among usually less vulnerable younger adults in this cohort. Thus, in early June 2020, we aimed to review the clinical data on all published cases of COVID-19 and concomitant AIS, with a view to understanding the pertinent clinical, laboratory and imaging features. The neutrophil-lymphocyte ratio (NLR) at time of hospital admission for COVID infection correlates positively with the duration of time before onset of clinical features of AIS. Higher NLR, C-Reactive protein, serum ferritin, D-dimer and fibrinogen levels are associated with poor prognosis of AIS in COVID-19 with 75% of patients dying or being severely disabled at present. Currently it is too early to comment on the long-term outcomes for survivors.

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“…VETs were performed using ROTEM (25 studies), TEG (15 studies), Quantra (two prospective studies [66,67]) and ClotPro (one retrospective study [24] and one case report [68]); no study compared two devices. Among articles reporting data about TEG, four were prospective studies [52,[59][60][61], ten were retrospective studies [51,[53][54][55][56][57][58][62][63][64], and one was a case report [65].…”

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

“…Testing was carried out either on admission or within the following days, but the timing of blood collection for VET was specified only for 29 studies [24,26,27,[29][30][31]33,[35][36][37][38]41,[43][44][45][46][47][48]50,53,[55][56][57][58][59][65][66][67]. In some studies, the measurements were repeated during the patientʹs stay, either because of a pre-established protocol [26,27,29,45,53,59,60,67] or because of the occurrence of a thromboembolic event [65,68]. Number of VETs performed during a patient's stay ranged from 1 to 5 [29].…”

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

“…Comorbidities: 1 Overweight and obesity, associated with high blood pressure, diabetes and cardiovascular risk factors; 2 High blood pressure, diabetes and some additional comorbidities; 3 Overweight and obesity, with some additional comorbidities; 4 Overweight and obesity; 5 Overweight and obesity, associated with high blood pressure, diabetes, pulmonary disease and cardiovascular risk factors; 6 Overweight and obesity, associated with high blood pressure; 7 Overweight and obesity, associated with cardiovascular risk factors, pulmonary disease and kidney disease; 8 Overweight and obesity, associated with diabetes, cardiovascular risk factors, pulmonary disease and kidney disease; 9 Overweight and obesity, associated with high blood pressure, diabetes, kidney disease and cardiovascular risk factors; 10 Overweight and obesity, associated with high blood pressure, diabetes, pulmonary disease, kidney disease and cardiovascular risk factors; 11 The number of COVID-19 patients with at least one VET performed in each article ranged from 1 [26,38,65] to 64 [58]. Mean or median adult COVID-19 patients ages ranged from 39 [65] to 84 years [68]. Excluding case reports, the proportion of women among the studies reporting gender ranged from 0 [40] to 50% [29,33,36].…”

Section: Characteristics Of the Included Patientsmentioning

confidence: 99%

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Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Bareille

Hardy

Douxfils

et al. 2021

JCM

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Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

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Procoagulatio, hypercoagulatio és fibrinolysis „shut down” kimutatása ClotPro® viszkoelasztikus tesztek segítségével COVID–19-betegekben.

Cited by 19 publications

References 9 publications

Greater Fibrinolysis Resistance but No Greater Platelet Aggregation in Critically Ill COVID-19 Patients

Greater Fibrinolysis Resistance but No Greater Platelet Aggregation in Critically Ill COVID-19 Patients

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

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