• Thiago Domingos Corrêa, Ricardo Luiz Cordioli, João Carlos Campos Guerra, Bruno Caldin da Silva, Dos Reis Rodrigues Roseny R 0000-0002-3796-5952 Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Guilherme Martins de Souza, Thais Dias Midega, Niklas Söderberg Campos, Bárbara Vieira Carneiro, Flávia Nunes Dias Campos, Hélio Penna Guimarães, de Matos Gustavo Faissol Janot GFJ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Valdir Fernandes de Aranda, and Rolim Ferraz Leonardo José LJ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil..
• Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
• Plos One. 2020 Jan 1; 15 (12): e0243604.

BackgroundCoagulation abnormalities in COVID-19 patients have not been addressed in depth.ObjectiveTo perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19.MethodsConventional 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.ResultsThirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, 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. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C ​​than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability.ConclusionCOVID-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 not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.

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