Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, Zhou X, Jiang W, Zhao YQ, Zhang SY, Li TS, et al.
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi. Date of publication 2020 Mar 28;volume 41(0):E006.
1. Zhonghua Xue Ye Xue Za Zhi. 2020 Mar 28;41(0):E006. doi:
10.3760/cma.j.issn.0253-2727.2020.0006. [Epub ahead of print]
[Clinical and coagulation characteristics of 7 patients with critical COVID-2019
pneumonia and acro-ischemia].
[Article in Chinese; Abstract available in Chinese from the publisher]
Zhang Y(1), Cao W(2), Xiao M(3), Li YJ(4), Yang Y(5), Zhao J(6), Zhou X(7), Jiang
W(8), Zhao YQ(1), Zhang SY(9), Li TS(2).
Author information:
(1)Department of Hematology, Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,
China.
(2)Department of Infection Disease, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing
100730, China.
(3)Department of Laboratory Medicine, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing
100730, China.
(4)Department of General Medicine, Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,
China.
(5)Department of orthopedics, Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,
China.
(6)Department of Respiratory and Critical Care Medicine Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical
College, Beijing 100730, China.
(7)Department of Intensive Care Unit, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing
100730, China.
(8)Department of Medical Intensive Care Unit, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,
Beijing 100730, China.
(9)Department of Cardiology, Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,
China.
Objective: To investigate the clinical and coagulation characteristics of the
critical Coronavirus disease 2019 (COVID-19) patients with acro-ischemia in the
intensive care unit (ICU). Methods: The retrospective study included 7 critical
COVID-19 patients with acro-ischemia in a single center in Wuhan, from Feb 4 to
Feb 15, 2020. The clinical and laboratory data before and during the ICU stay
were analyzed. Results: The median age of 7 patients was 59 years and 4 of them
were men. 3 of them were associated with underlying comorbidities. Fever, cough,
dyspnea and diarrhea were common clinical symptoms. All patients had
acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry
gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were
significantly elevated in most patients. Prothrombin time (PT) were prolonged in
4 patients. D-dimer and FDP levels increased progressively when COVID-2019
exacerbated, and 4 patients were diagnosed with definite disseminated
intravascular coagulation (DIC). 6 patients received low molecular weight heparin
(LMWH) treatment, after which their D-dimer and FDP decreased, but there was no
significant improvement in clinical symptoms. 5 patients died finally and the
median time from acro-ischemia to death was 12 days. Conclusions: The existence
of hypercoagulation status in critical COVID-2019 patients should be monitored
closely, and anticoagulation therapy can be considered in selected patients. More
clinical data is needed to investigate the role of anticoagulation in COVID-2019
treatment.
Publisher: 目的： 总结合并肢端缺血的新型冠状病毒肺炎（COVID-19）患者的临床和凝血参数特征。 方法：
回顾性分析2020年2月5日至2020年2月15日，北京协和医院国家医疗队在武汉收治的7例危重型COVID-19患者临床及实验室资料。 结果：
7例患者中男性4例，女性3例，中位年龄59（49～71）岁；3例合并基础病。临床表现为发热7例、干咳6例、呼吸困难4例、腹泻4例。所有患者均存在不同程度的肢端缺血
，表现为肢端青斑/青紫、血疱、干性坏疽等。7例患者入住重症监护室时均存在D-二聚体显著升高，血小板计数均正常，6例纤维蛋白原升高及纤维蛋白降解产物（FDP）升高，
4例凝血酶原时间（PT）延长。随病情进展，D-二聚体及FDP进行性升高，4例患者符合2017年中国弥散性血管内凝血诊断标准。其中6例患者接受低分子肝素治疗，治疗后
D-二聚体及FDP下降，但临床症状无明显好转。中位随访26天，5例患者死亡，从肢端缺血症状出现至死亡的中位时间为12（7～16）d。 结论：
部分危重型COVID-19患者存在明显高凝倾向，应关注此类患者凝血参数，及时识别高凝期并予抗凝治疗。肢端缺血表现为预后不良提示。抗凝治疗能否改善预后仍需更多临床数
据。.
DOI: 10.3760/cma.j.issn.0253-2727.2020.0006
PMID: 32220276
