• Mauro Panigada, Nicola Bottino, Paola Tagliabue, Giacomo Grasselli, Cristina Novembrino, Veena Chantarangkul, Antonio Pesenti, Flora Peyvandi, and Armando Tripodi.
• Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy.
• J. Thromb. Haemost. 2020 Jul 1; 18 (7): 1738-1742.

BackgroundThe severe inflammatory state secondary to COVID-19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D-dimer, as well as low fibrinogen.AimsWhole blood from 24 patients admitted at the intensive care unit because of COVID-19 was collected and evaluated with thromboelastography by the TEG point-of-care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis.ResultsTEG parameters are consistent with a state of hypercoagulability as shown by decreased values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal). Fibrinogen was increased and D-dimer was dramatically increased. C-reactive protein was increased. Factor VIII and von Willebrand factor (n = 11) were increased. Antithrombin (n = 11) was marginally decreased and protein C (n = 11) was increased.ConclusionThe results of this cohort of patients with COVID-19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/treatment. Clinical trials are urgently needed to establish the type of drug, dosage, and optimal duration of prophylaxis.© 2020 International Society on Thrombosis and Haemostasis.

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