Coagulation profile of COVID-19 patients admitted to the ICU: an exploratory study

Background Coagulation abnormalities in COVID-19 patients have not been
addressed in depth. Objective: To perform a longitudinal evaluation of
coagulation profile of patients admitted to the ICU with COVID-19. Methods
Conventional coagulation tests, rotational thromboelastometry (ROTEM),
platelet function, fibrinolysis, antithrombin, protein C and S were
measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA
score, patients were divided in two groups: SOFA ≤ 10 and SOFA >
10. Results Thirty patients were studied. Conventional coagulation tests
remained unchanged during the study period, while the majority of patients
exhibited a hypercoagulability state based on ROTEM. Fibrinogen levels
were increased in both groups. ROTEM maximum clot firmness increased in
both groups. ROTEM – FIBTEM maximum clot firmness was high in both groups,
with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a
slight increase during the same period in group SOFA > 10.
Fibrinolysis was low and decreased over time in all groups, with the most
pronounced decrease observed in INTEM maximum lysis in group SOFA >
10. Protein C plasma levels increased over time in both groups, although
patients in group SOFA > 10 exhibited lower values in comparison to
patients in group SOFA ≤ 10. Conclusion COVID-19 patients have a
pronounced hypercoagulability state, characterized by impaired endogenous
anticoagulation and decreased fibrinolysis. The magnitude of coagulation
abnormalities seems to correlate with the severity of organ dysfunction.
The hypercoagulability state of COVID-19 patients was only detected by
ROTEM.