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COVID-19 Associated Coagulopathy: The Thrombin Burst

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The Coagulation Labyrinth of Covid-19

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Abstract

Thrombin is the cornerstone of the coagulation process. Without thrombin, fibrinogen cannot be converted into fibrin, and no stable clot can be formed. Thrombin generation (TG) is a complex process; however, the major driver of in vivo thrombin generation is tissue factor (TF). TF is in turn produced when the endothelial layer is destroyed (finalistic process) but can be released by a number of cells, and namely monocytes (blood-borne TF). In this second case, under inflammatory/infective reaction, TF represents the link between inflammation and coagulation. Given the infective and inflammatory pattern of COVID-19, the pattern of TG in severe cases of COVID-19 is of potential interest, particularly in the setting of the well-known thrombotic complications of this disease. TG can be addressed with different laboratory assays; however, the conventional tests (prothrombin time and activated partial thromboplastin time) are highly nonspecific, and offer a limited information. Point-of-care coagulation tests reflect similar limitations when the reaction time is considered as a marker of TG. Therefore, more specific, nonconventional tests are required to address TG in the setting of COVID-19. These include computerized automated thrombography (CAT), the measure of thrombin inactivation by antithrombin (thrombin-antithrombin complex, TAT), and of the marker of TG prothrombin fragment 1.2 (PF 1.2). Even considering that many biases are to be considered (severity of the disease, presence of thromboembolic complications, and, most of all, different degrees of pharmacological anticoagulation), the existing studies offer a scenario of a “thrombin burst” that is probably of higher degree than what is observed in other sepsis patterns, and that often appears resistant to the standard anticoagulant therapies.

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  1. Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Marco Ranucci & Tommaso Aloisio

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  1. Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Marco Ranucci

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Ranucci, M., Aloisio, T. (2022). COVID-19 Associated Coagulopathy: The Thrombin Burst. In: Ranucci, M. (eds) The Coagulation Labyrinth of Covid-19. Springer, Cham. https://doi.org/10.1007/978-3-030-82938-4_4

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  • DOI: https://doi.org/10.1007/978-3-030-82938-4_4

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