Characteristics of coagulation/fibrinolysis abnormalities in severe novel coronavirus disease 2019 (COVID-19) patients —Case series—

Abstract

[Hiroyasu Ishikura *, Junichi Maruyama, Yuhei Irie, Yoshito Izumiya, Mako Naito, Megumi Koie, Kodai Hoshino, Yoshihiko Nakamura Summary: This time, the coagulation line of severe new coronavirus 2019 (COVID-19) patients We report some findings on the melting anomaly. There were 6 cases, and only 1 case decreased the platelet count below 10 × 10 4 /mm 3 within 8 days after admission to the ICU. The prothrombin time-international normalized ratio (PT-INR) was almost normal throughout the course, and the activated partial thromboplastin time (APTT) exceeded the upper limit of normal in 5 cases, but did not significantly extend except 1 case. On the other hand, FDP and D-dimer remained above the normal upper limit during the course of time, and in 2 cases, marked re-elevation occurred after the 7th day of illness. Based on the above, in severe COVID-19 patients, despite the infection, coagulation and fibrinolysis abnormalities did not appear to be “fibrinolysis-suppressive”, but rather “fibrinolysis-promoting”. Of the 6 cases, 4 cases were diagnosed with DIC based on the Japanese Association for Acute Medicine criteria (JAAM) disseminated intravascular coagulation (DIC) diagnostic criteria, and recombinant human soluble tronmodulin (rhsTM) was administered, and 3 cases were completed. At that point, he left the DIC.] 石倉宏恭 * ，丸山隼一，入江悠平，泉谷義人，内藤麻巳子，鯉江めぐみ， 星野耕大，仲村佳彦 要約：今回，重症新型コロナウィルス 2019（Coronavirus disease 2019: COVID-19）患者の凝固線溶 異常について，若干の知見を得たので報告する．症例は 6 症例で，ICU 入室から 8 日間の経過で血 小板数が 10×10 4 /mm 3 未満に低下したのは 1 例のみであった．prothrombin time-international normalized ratio（PT-INR）は経過を通じて概ね正常で，activated partial thromboplastin time（APTT）は経過中 5 例で正常上限を上回ったが，1 例を除き大きく延長する事は無かった．一方，FDP と D-dimer は経 過中，正常上限を超えて推移し，2 例は第 7 病日以降に著明な再上昇を来した．以上より，重症 COVID-19 患者は感染症にも関わらず，凝固線溶異常は「線溶抑制型」でなく，あたかも「線溶亢 進型」の様相を呈していた．6 例中 4 例が Japanese Association for Acute Medicine criteria（JAAM） disseminated intravascular coagulation（DIC）診断基準で DIC と診断され，遺伝子組換え型ヒト可溶性 トロンモジュリン（rhsTM）が投与され，3 例が投与終了時点で DIC から離脱した．