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10.1007/s11239-020-02226-0

http://scihub22266oqcxt.onion/10.1007/s11239-020-02226-0
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suck abstract from ncbi


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pmid32671609      J+Thromb+Thrombolysis 2021 ; 51 (2): 308-312
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  • High D dimers and low global fibrinolysis coexist in COVID19 patients: what is going on in there? #MMPMID32671609
  • Ibanez C; Perdomo J; Calvo A; Ferrando C; Reverter JC; Tassies D; Blasi A
  • J Thromb Thrombolysis 2021[Feb]; 51 (2): 308-312 PMID32671609show ga
  • BACKGROUD: COVID-19 coagulopathy linked to increased D-dimer levels has been associated with high mortality (Fei Z et al. in Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England) 395(10229):1054-62, 2020). While D-dimer is accepted as a disseminated intravascular coagulation marker, rotational thromboelastometry (ROTEM) also detects fibrinolysis (Wright FL et al. in Fibrinolysis shutdown correlates to thromboembolic events in severe COVID-19 infection. J Am Coll Surg (2020). Available from https://pubmed.ncbi.nlm.nih.gov/32422349/ [cited 14 Jun 2020]; Schmitt FCF et al. in Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study. Ann Intensive Care 9(1):19, 2019). We describe the ROTEM profile in severely ill COVID-19 patients and compare it with the standard laboratory coagulation test. METHODS: Adult patients diagnosed with COVID-19 admitted to the ICU were prospectively enrolled after Ethics Committee approval (HCB/2020/0371). All patients received venous thromboembolism prophylaxis; those on therapeutic anticoagulation were excluded. The standard laboratory coagulation test and ROTEM were performed simultaneously at 24-48 h after ICU admission. Sequential organ failure assessment (SOFA), disseminated intravascular coagulation (DIC) and sepsis-induced coagulopathy (SIC) scores were calculated at sample collection. RESULTS: Nineteen patients were included with median SOFA-score of 4 (2-6), DIC-score of 1 (0-3) and SIC-score of 1.8 (0.9). Median fibrinogen, D-dimer levels and platelet count were 6.2 (4.8-7.6 g/L), 1000 (600-4200 ng/ml) and 236 (136-364 10(9)/L), respectively. Clot firmness was above the normal range in the EXTEM and FIBTEM tests while clot lysis was decreased. There was no significant correlation between ROTEM or D-dimer parameters and the SOFA score. CONCLUSION: In COVID-19 patients, the ROTEM pattern was characterized by a hypercoagulable state with decreased fibrinolytic capacity despite a paradoxical increase in D-dimer levels. We suggest that, in COVID-19 patients, the lungs could be the main source of D-dimer, while a systemic hypofibrinolytic state coexists. This hypothesis should be confirmed by future studies.
  • |*COVID-19 Drug Treatment[MESH]
  • |*COVID-19/blood[MESH]
  • |*Fibrinolysis[MESH]
  • |*Thromboembolism/blood/drug therapy[MESH]
  • |Aged[MESH]
  • |Anticoagulants/*administration & dosage[MESH]
  • |Female[MESH]
  • |Fibrin Fibrinogen Degradation Products/*metabolism[MESH]
  • |Humans[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Retrospective Studies[MESH]
  • |SARS-CoV-2/*metabolism[MESH]


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