(Kong Robert) - Brighton and Sussex University Hospitals NHS Trust Department of Anesthesia
(Hutchinson Nevil) - Brighton and Sussex University Hospitals NHS Trust Department of Anesthesia
(Gorlinger Klaus) - University Duisburg-Essen University Hospital Essen Department of Anesthesiology and Intensive Care Medicine
Abstract
Background: Coronavirus disease (COVID-19)-associated coagulopathy is most often characterized by elevated D-dimer, interleukin-6, and plasma fibrinogen concentrations as well as hypercoagulability in thromboelastometry with increased clot firmness in the EXTEM, INTEM, and FIBTEM assays. Clinically, it manifests with a very high incidence of thrombosis, particularly in the pulmonary system, whereas bleeding complications are infrequent.
Case: Here, we describe two critically ill patients with COVID-19 admitted to our intensive care unit demonstrating different thromboelastometry and biomarker patterns. One patient presented with hypercoagulability and the other patient with hypocoagulability and fibrinolysis shutdown in thromboelastometry. The pathophysiology and the potential impact on treatment options are discussed.
Conclusions: A combination of biomarkers and thromboelastometry results can be helpful in the future to decide which therapeutic strategy might be most appropriate for critically ill patients with COVID-19. This would be an important step to establish precision medicine in this high-risk patient population.
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Anticoagulants, COVID-19, Fibrinolysis, Hemostasis, Thrombelastography, Thrombosis
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Thrs two case reports indicated that A combination of biomarkers and thromboelastometry results can be helpful in the future to decide which therapeutic strategy might be most appropriate for critically ill patients with COVID-19.