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Critical Care
Published in: Critical Care 1/2020

Open Access 01-12-2020 | COVID-19 | Research

Thromboembolic complications in critically ill COVID-19 patients are associated with impaired fibrinolysis

Authors: Jan Matthias Kruse, Abakar Magomedov, Annika Kurreck, Frédéric H. Münch, Roland Koerner, Julian Kamhieh-Milz, Andreas Kahl, Inka Gotthardt, Sophie K. Piper, Kai-Uwe Eckardt, Thomas Dörner, Daniel Zickler

Published in: Critical Care | Issue 1/2020

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Abstract

Background

There is emerging evidence for enhanced blood coagulation in coronavirus 2019 (COVID-19) patients, with thromboembolic complications contributing to morbidity and mortality. The mechanisms underlying this prothrombotic state remain enigmatic. Further data to guide anticoagulation strategies are urgently required.

Methods

We used viscoelastic rotational thromboelastometry (ROTEM) in a single-center cohort of 40 critically ill COVID-19 patients.

Results

Clear signs of a hypercoagulable state due to severe hypofibrinolysis were found. Maximum lysis, especially following stimulation of the extrinsic coagulation system, was inversely associated with an enhanced risk of thromboembolic complications. Combining values for maximum lysis with D-dimer concentrations revealed high sensitivity and specificity of thromboembolic risk prediction.

Conclusions

The study identifies a reduction in fibrinolysis as an important mechanism in COVID-19-associated coagulopathy. The combination of ROTEM and D-dimer concentrations may prove valuable in identifying patients requiring higher intensity anticoagulation.
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Metadata
Title
Thromboembolic complications in critically ill COVID-19 patients are associated with impaired fibrinolysis
Authors
Jan Matthias Kruse
Abakar Magomedov
Annika Kurreck
Frédéric H. Münch
Roland Koerner
Julian Kamhieh-Milz
Andreas Kahl
Inka Gotthardt
Sophie K. Piper
Kai-Uwe Eckardt
Thomas Dörner
Daniel Zickler
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
COVID-19
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03401-8

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