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Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection

Objectives  Thrombotic and bleeding complications are common in COVID-19 disease. In a prospective study, we performed a comprehensive panel of tests to predict the risk of bleeding and thrombosis in patients admitted with hypoxic respiratory failure due to severe COVID-19 infection. Methods  We per...

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Autores principales: Hadique, Sarah, Badami, Varun, Sangani, Rahul, Forte, Michael, Alexander, Talia, Goswami, Aarti, Garrison, Adriana, Wen, Sijin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763459/
https://www.ncbi.nlm.nih.gov/pubmed/35059556
http://dx.doi.org/10.1055/s-0041-1742225
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author Hadique, Sarah
Badami, Varun
Sangani, Rahul
Forte, Michael
Alexander, Talia
Goswami, Aarti
Garrison, Adriana
Wen, Sijin
author_facet Hadique, Sarah
Badami, Varun
Sangani, Rahul
Forte, Michael
Alexander, Talia
Goswami, Aarti
Garrison, Adriana
Wen, Sijin
author_sort Hadique, Sarah
collection PubMed
description Objectives  Thrombotic and bleeding complications are common in COVID-19 disease. In a prospective study, we performed a comprehensive panel of tests to predict the risk of bleeding and thrombosis in patients admitted with hypoxic respiratory failure due to severe COVID-19 infection. Methods  We performed a single center (step down and intensive care unit [ICU] at a quaternary care academic hospital) prospective study. Sequentially enrolled adult (≥18 years) patients were admitted with acute hypoxic respiratory failure due to COVID-19 between June 2020 and November 2020. Several laboratory markers of coagulopathy were tested after informed and written consent. Results  Thirty-three patients were enrolled. In addition to platelet counts, prothrombin time, and activated partial thromboplastin time, a series of protocol laboratories were collected within 24 hours of admission. These included Protein C, Protein S, Antithrombin III, ADAMTS13, fibrinogen, ferritin, haptoglobin, and peripheral Giemsa smear. Patients were then monitored for the development of hematological (thrombotic and bleeding) events and followed for 30 days after discharge. Twenty-four patients (73%) required ICU admissions. At least one laboratory abnormality was detected in 100% of study patients. Nine patients (27%) suffered from significant hematological events, and four patients had a clinically significant bleeding event requiring transfusion. No significant association was observed between abnormalities of coagulation parameters and the incidence of hematologic events. However, a higher SOFA score (10.89 ± 3.48 vs. 6.92 ± 4.10, p  = 0.016) and CKD (5/9 [22.2%] vs. 2/24 [12.5%] p  = 0.009) at baseline were associated with the development of hematologic events. 33.3% of patients died at 30 days. Mortality was similar in those with and without hematological events. Reduced ADAMTS13 level was significantly associated with mortality. Conclusion  Routine extensive testing of coagulation parameters did not predict the risk of bleeding and thrombosis in COVID-19 patients. Thrombotic and bleeding events in COVID-19 patients are not associated with a higher risk of mortality. Interestingly, renal dysfunction and a high SOFA score were found to be associated with increased risk of hematological events.
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spelling pubmed-87634592022-01-19 Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection Hadique, Sarah Badami, Varun Sangani, Rahul Forte, Michael Alexander, Talia Goswami, Aarti Garrison, Adriana Wen, Sijin TH Open Objectives  Thrombotic and bleeding complications are common in COVID-19 disease. In a prospective study, we performed a comprehensive panel of tests to predict the risk of bleeding and thrombosis in patients admitted with hypoxic respiratory failure due to severe COVID-19 infection. Methods  We performed a single center (step down and intensive care unit [ICU] at a quaternary care academic hospital) prospective study. Sequentially enrolled adult (≥18 years) patients were admitted with acute hypoxic respiratory failure due to COVID-19 between June 2020 and November 2020. Several laboratory markers of coagulopathy were tested after informed and written consent. Results  Thirty-three patients were enrolled. In addition to platelet counts, prothrombin time, and activated partial thromboplastin time, a series of protocol laboratories were collected within 24 hours of admission. These included Protein C, Protein S, Antithrombin III, ADAMTS13, fibrinogen, ferritin, haptoglobin, and peripheral Giemsa smear. Patients were then monitored for the development of hematological (thrombotic and bleeding) events and followed for 30 days after discharge. Twenty-four patients (73%) required ICU admissions. At least one laboratory abnormality was detected in 100% of study patients. Nine patients (27%) suffered from significant hematological events, and four patients had a clinically significant bleeding event requiring transfusion. No significant association was observed between abnormalities of coagulation parameters and the incidence of hematologic events. However, a higher SOFA score (10.89 ± 3.48 vs. 6.92 ± 4.10, p  = 0.016) and CKD (5/9 [22.2%] vs. 2/24 [12.5%] p  = 0.009) at baseline were associated with the development of hematologic events. 33.3% of patients died at 30 days. Mortality was similar in those with and without hematological events. Reduced ADAMTS13 level was significantly associated with mortality. Conclusion  Routine extensive testing of coagulation parameters did not predict the risk of bleeding and thrombosis in COVID-19 patients. Thrombotic and bleeding events in COVID-19 patients are not associated with a higher risk of mortality. Interestingly, renal dysfunction and a high SOFA score were found to be associated with increased risk of hematological events. Georg Thieme Verlag KG 2022-01-17 /pmc/articles/PMC8763459/ /pubmed/35059556 http://dx.doi.org/10.1055/s-0041-1742225 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Hadique, Sarah
Badami, Varun
Sangani, Rahul
Forte, Michael
Alexander, Talia
Goswami, Aarti
Garrison, Adriana
Wen, Sijin
Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection
title Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection
title_full Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection
title_fullStr Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection
title_full_unstemmed Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection
title_short Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection
title_sort coagulation studies are not predictive of hematological complications of covid-19 infection
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763459/
https://www.ncbi.nlm.nih.gov/pubmed/35059556
http://dx.doi.org/10.1055/s-0041-1742225
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