Insights into Fibrinogen-Mediated COVID-19 Hypercoagubility in Critically Ill Patients.
J Neurosurg Anesthesiol
; 34(1): 136-140, 2022 Jan 01.
Article
in English
| MEDLINE | ID: covidwho-1555809
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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Tissue Plasminogen Activator
/
COVID-19
Limits:
Humans
Language:
English
Journal:
J Neurosurg Anesthesiol
Journal subject:
Anesthesiology
/
Neurosurgery
Year:
2022
Document Type:
Article
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