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10.1016/j.jamcollsurg.2020.05.007

http://scihub22266oqcxt.onion/10.1016/j.jamcollsurg.2020.05.007
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32422349!7227511!32422349
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suck abstract from ncbi


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pmid32422349      J+Am+Coll+Surg 2020 ; 231 (2): 193-203.e1
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  • Fibrinolysis Shutdown Correlation with Thromboembolic Events in Severe COVID-19 Infection #MMPMID32422349
  • Wright FL; Vogler TO; Moore EE; Moore HB; Wohlauer MV; Urban S; Nydam TL; Moore PK; McIntyre RC Jr
  • J Am Coll Surg 2020[Aug]; 231 (2): 193-203.e1 PMID32422349show ga
  • BACKGROUND: COVID-19 predisposes patients to a prothrombotic state with demonstrated microvascular involvement. The degree of hypercoagulability appears to correlate with outcomes; however, optimal criteria to assess for the highest-risk patients for thrombotic events remain unclear; we hypothesized that deranged thromboelastography measurements of coagulation would correlate with thromboembolic events. STUDY DESIGN: Patients admitted to an ICU with COVID-19 diagnoses who had thromboelastography analyses performed were studied. Conventional coagulation assays, d-dimer levels, and viscoelastic measurements were analyzed using a receiver operating characteristic curve to predict thromboembolic outcomes and new-onset renal failure. RESULTS: Forty-four patients with COVID-19 were included in the analysis. Derangements in coagulation laboratory values, including elevated d-dimer, fibrinogen, prothrombin time, and partial thromboplastin time, were confirmed; viscoelastic measurements showed an elevated maximum amplitude and low lysis of clot at 30 minutes. A complete lack of lysis of clot at 30 minutes was seen in 57% of patients and predicted venous thromboembolic events with an area under the receiver operating characteristic curve of 0.742 (p = 0.021). A d-dimer cutoff of 2,600 ng/mL predicted need for dialysis with an area under the receiver operating characteristic curve of 0.779 (p = 0.005). Overall, patients with no lysis of clot at 30 minutes and a d-dimer > 2,600 ng/mL had a venous thromboembolic event rate of 50% compared with 0% for patients with neither risk factor (p = 0.008), and had a hemodialysis rate of 80% compared with 14% (p = 0.004). CONCLUSIONS: Fibrinolysis shutdown, as evidenced by elevated d-dimer and complete failure of clot lysis at 30 minutes on thromboelastography predicts thromboembolic events and need for hemodialysis in critically ill patients with COVID-19. Additional clinical trials are required to ascertain the need for early therapeutic anticoagulation or fibrinolytic therapy to address this state of fibrinolysis shutdown.
  • |*Blood Coagulation Tests[MESH]
  • |Adult[MESH]
  • |Aged[MESH]
  • |Aged, 80 and over[MESH]
  • |Betacoronavirus[MESH]
  • |COVID-19[MESH]
  • |Coronavirus Infections/*blood/physiopathology/therapy[MESH]
  • |Female[MESH]
  • |Fibrin Clot Lysis Time[MESH]
  • |Fibrin Fibrinogen Degradation Products/analysis[MESH]
  • |Fibrinolysis/*physiology[MESH]
  • |Humans[MESH]
  • |Intensive Care Units[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Pandemics[MESH]
  • |Partial Thromboplastin Time[MESH]
  • |Pneumonia, Viral/*blood/physiopathology/therapy[MESH]
  • |Renal Dialysis[MESH]
  • |Risk Factors[MESH]
  • |SARS-CoV-2[MESH]
  • |Thrombelastography[MESH]


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