COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis

Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of <300 mmHg Laboratory tests were performed for parameters of haemostasis, clot waveform analysis and anti-phospholipid antibodies CWA parameters were raised with elevated aPTT median Min1 (clot velocity) 9 3%/s (IQR 7 1-9 9%/s), elevated PT median Min1 10 3%/s (IQR 7 1-11 1%/s), elevated aPTT median Min2 (clot acceleration) 1 5%/s(2) (IQR 1 0-1 6%/s(2)), elevated PT median Min2 5 2%/s(2) (3 6-5 7%/s(2)), elevated aPTT median Max2 (clot deceleration) 1 3%/s(2) (IQR 0 8-1 4%/s(2)) elevated PT median Max2 3 8%/s(2) (IQR 2 6-4 2%/s(2)), increased aPTT median Delta change (decreased light transmission due to increased clot formation) 87 8% (IQR 70 2-91 8%) and PT median Delta change 33 0% This together with raised median Factor VIII levels of 262 5%, hyperfibrinogenemia (median fibrinogen levels 7 5 g/L), increased median von Willebrand factor antigen levels 320% and elevated median D-dimer levels 1 7 μg/dl support the diagnosis of COVID-19 associated coagulopathy A lupus anticoagulant was present in 50% of patients Our laboratory findings further support the view that severe SARS-CoV-2 infection is associated with a state of hypercoagulability