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    Association of D-dimer and fibrinogen magnitude with hypercoagulability HP hypercoagulability MESHD by thromboelastography in severe COVID-19

    Authors: Abhimanyu Chandel; Saloni Patolia; Mary Looby; Heidi Dalton; Najeebah Bade; Vikramjit Khangoora; Mehul Desai; James Lantry; Erik Osborn; Svetolik Djurkovic; Daniel Tang; Steven D Nathan; Christopher S King

    doi:10.1101/2020.07.27.20162842 Date: 2020-07-29 Source: medRxiv

    Introduction: D-dimer concentration has been used to identify candidates for intensified anticoagulant treatment for both venous thromboembolism MESHD thromboembolism HP prevention and mitigation of the microthrombotic complications MESHD associated with COVID-19. Thromboelastography (TEG) maximum amplitude (MA) has been validated as an indicator of hypercoagulability HP hypercoagulability MESHD and MA [≥] 68 mm has been utilized as a marker of hypercoagulability HP hypercoagulability MESHD in other conditions. We evaluated the relationship between coagulation, inflammatory, and TEG parameters in patients with COVID-19 on extracorporeal membrane oxygenation (ECMO). Methods: We performed a single center retrospective analysis of consecutive patients that received ECMO for the treatment of COVID-19. TEG, inflammatory, and coagulation markers were compared in patients with and without thrombotic complications MESHD. Correlation tests were performed to identify the coagulation and inflammatory markers that best predict hypercoagulability HP hypercoagulability MESHD as defined by an elevated TEG MA. Results: 168 TEGs were available in 24 patients. C-reactive protein and fibrinogen were significantly higher in patients that developed a thrombotic MESHD event versus those that did not (p=0.038 and p=0.043 respectively). D-dimer was negatively correlated with TEG MA (p<0.001) while fibrinogen was positively correlated (p<0.001). A fibrinogen > 441 mg/dL had a sensitivity SERO of 91.2% and specificity of 85.7% for the detection of MA [≥] 68 mm. Conclusions: In critically ill MESHD patients with COVID-19, D-dimer concentration had an inverse relationship with hypercoagulability HP hypercoagulability MESHD as measured by TEG MA. D-dimer elevation may reflect severity of COVID-19 related sepsis HP sepsis MESHD rather than designate patients likely to benefit from anticoagulation. Fibrinogen concentration may represent a more useful marker of hypercoagulability HP hypercoagulability MESHD in this population.

    COVID-19 induces a hyperactive MESHD phenotype in circulating platelets

    Authors: Shane P Comer; Sarah Cullivan; Paulina B Szklanna; Luisa Weiss; Steven Cullen; Sarah Kelliher; Albert Smolenski; Niamh Moran; Claire Murphy; Haidar Altaie; John Curran; Katherine O'Reilly; Aoife G Cotter; Brian Marsh; Sean Gaine; Patrick Mallon; Brian McCullagh; Fionnuala Ní Áinle; Barry Kevane; Patricia B Maguire

    doi:10.1101/2020.07.24.20156240 Date: 2020-07-26 Source: medRxiv

    Background Coronavirus disease MESHD 2019 (COVID-19), caused by novel coronavirus SARS-CoV-2 MESHD, has to date affected over 13.3 million globally. Although high rates of venous thromboembolism MESHD thromboembolism HP and evidence of COVID-19-induced endothelial dysfunction have been reported, the precise aetiology of the increased thrombotic MESHD risk associated with COVID-19 infection MESHD remains to be fully elucidated. Objectives Here, we assessed clinical platelet parameters and circulating platelet activity in patients with severe and non-severe COVID-19. Methods An assessment of clinical blood SERO parameters in patients with severe COVID-19 disease MESHD (requiring intensive care), patients with non-severe disease (not requiring intensive care), general medical in-patients without COVID-19 and healthy donors was undertaken. Platelet function and activity were also assessed by secretion and specific marker analysis. Results We show that routine clinical blood SERO parameters including increased MPV and decreased platelet:neutrophil ratio are associated with disease severity in COVID-19 upon hospitalisation and intensive care unit admission. Strikingly, agonist-induced ADP release was dramatically higher in COVID-19 patients compared with non-COVID-19 hospitalized patients and circulating levels of PF4, sP-selectin and TPO were also significantly elevated in COVID-19. Conclusion Distinct differences exist in routine full blood SERO count and other clinical laboratory parameters between patients with severe and non-severe COVID-19. Moreover, we have determined that COVID-19 patients possess hyperactive circulating platelets. These data suggest that abnormal platelet reactivity may contribute to hypercoagulability HP hypercoagulability MESHD in COVID-19. Further investigation of platelet function in COVID-19 may provide additional insights into the aetiology of thrombotic risk in this disease and may contribute to the optimisation of thrombosis MESHD prevention and treatment strategies.

    COVID-19 and Ischemic Stroke HP Stroke MESHD

    Authors: Amira Sidig; Khabab Abbasher; Hussien Abbasher; Radi Tofaha Alhusseini; Mohamed Elsayed; Mohammed Abbasher; Sufian Khalid M. N; Khalid Hajnoor; Mohammed Malekaldar; Mutaz F. Digna; Abbasher Hussien; Omer Eladil A. Hamid

    doi:10.21203/rs.3.rs-49338/v1 Date: 2020-07-26 Source: ResearchSquare

    Background: SARS-CoV-2 causes COVID-19 disease. It was identified in December 2019 and rapidly evolved into a pandemic. During the outbreak of COVID-19, researches demonstrated its effect on many systems, including the nervous system. In our clinic, we have reported an impact of SARS-CoV-2, causing the ischaemic stroke MESHD stroke HP.Case Report: A 62-year-old Sudanese male TRANS with some comorbidities brought to the A&E with fever HP fever MESHD, chest symptoms MESHD, and acute evolving left-sided hemiplegia HP hemiplegia MESHD power grade 0/5 MRCS with left upper motor neuron facial palsy HP facial palsy MESHD. Investigations: CT brain: right middle cerebral artery MCA infarction MESHD. CT- chest: bilateral ground-glass appearance. COVID-19 Test was positive. elevated D-dimer and C-reactive protein.Discussion: A retrospective study of data from the COVID-19 outbreak in China showed that the incidence of stroke HP stroke MESHD among hospitalized patients was approximately 5%. The fact that COVID-19 is an acute inflammatory condition associated with an increased incidence of fatty plaques formation, injury of the vascular wall, and hypercoagulability HP hypercoagulability MESHD, causing brain infarct MESHD can be a reasonable hypothesis.ConclusionPatients with COVID-19 are at increased risk of thrombo-embolization MESHD, leading to arterial and venous cerebrovascular accident MESHD. This case report enhances the importance of further studies to clarify the relationship between stroke HP stroke MESHD and COVID-19.

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