• COVID-19 Associated Hypercoagulability: Manifestations, Mechanisms, and Management

      Mazzeffi, M.A.; Chow, J.H.; Tanaka, K. (Wolters Kluwer Health, 2021-04)
      ABSTRACT: Patients with severe coronavirus disease-2019 (COVID-19) frequently have hypercoagulability caused by the immune response to the severe acute respiratory syndrome coronavirus-2 infection. The pathophysiology of COVID-19 associated hypercoagulability is not fully understood, but characteristic changes include: increased fibrinogen concentration, increased Factor VIII activity, increased circulating von Willebrand factor, and exhausted fibrinolysis. Anticoagulant therapy improves outcomes in mechanically ventilated patients with COVID-19 and viscoelastic coagulation testing offers an opportunity to tailor anticoagulant therapy based on an individual patient's coagulation status. In this narrative review, we summarize clinical manifestations of COVID-19, mechanisms, monitoring considerations, and anticoagulant therapy. We also review unique considerations for COVID-19 patients who are on extracorporeal membrane oxygenation. Copyright Copyright 2020 by the Shock Society.
    • Factor VIII and Functional Protein C Activity in Critically Ill Patients With Coronavirus Disease 2019: A Case Series

      Tabatabai, A.; Rabin, J.; Menaker, J.; Madathil, R.; Galvagno, S.; Menne, A.; Chow, J.H.; Herr, D.; Tanaka, K.; Scalea, T.; et al. (Wolters Kluwer Health, 2020)
      Critically ill patients with coronavirus disease 2019 (COVID-19) have been observed to be hypercoagulable, but the mechanisms for this remain poorly described. Factor VIII is a procoagulant factor that increases during inflammation and is cleaved by activated protein C. To our knowledge, there is only 1 prior study of factor VIII and functional protein C activity in critically ill patients with COVID-19. Here, we present a case series of 10 critically ill patients with COVID-19 who had severe elevations in factor VIII activity and low normal functional protein C activity, which may have contributed to hypercoagulability.
    • Thromboelastometry and D-Dimer Elevation in Coronavirus-2019

      Madathil, R.J.; Tabatabai, A.; Rabin, J.; Menne, A.R.; Henderson, R.; Mazzeffi, M.; Scalea, T.M.; Tanaka, K. (W.B. Saunders, 2020)