Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate.

Abstract

Critical illnesses associated with coronavirus disease 2019 (COVID-19) are attributable to a hypercoagulable status. There is limited knowledge regarding the dynamic changes in coagulation factors among COVID-19 patients on nafamostat mesylate, a potential therapeutic anticoagulant for COVID-19. First, we retrospectively conducted a cluster analysis based on clinical characteristics on admission to identify latent subgroups among fifteen patients with COVID-19 on nafamostat mesylate at the University of Tokyo Hospital, Japan, between April 6 and May 31, 2020. Next, we delineated the characteristics of all patients as well as COVID-19-patient subgroups and compared dynamic changes in coagulation factors among each subgroup. The subsequent dynamic changes in fibrinogen and D-dimer levels were presented graphically. All COVID-19 patients　were classified into three subgroups: clusters A, B, and C, representing low, intermediate, and high risk of poor outcomes, respectively. All patients were alive 30 days from symptom onset. No patient in cluster A required mechanical ventilation; however, all patients in cluster C required mechanical ventilation, and half of them were treated with venovenous extracorporeal membrane oxygenation. All patients in cluster A maintained low D-dimer levels, but some critical patients in clusters B and C showed dynamic changes in fibrinogen and D-dimer levels. Although the potential of nafamostat mesylate needs to be evaluated in randomized clinical trials, admission characteristics of patients with COVID-19 could predict subsequent coagulopathy.

• Authors: Itsuki Osawa, Koh Okamoto, Mahoko Ikeda, Amato Otani, Yuji Wakimoto, Marie Yamashita, Takayuki Shinohara, Yoshiaki Kanno, Daisuke Jubishi, Makoto Kurano, Sohei Harada, Shu Okugawa, Yutaka Yatomi, Kyoji Moriya
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) Vol. 51 Issue 3 Pg. 649-656 (Apr 2021) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 32920751 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Benzamidines
• Fibrin Fibrinogen Degradation Products
• Guanidines
• fibrin fragment D
• Fibrinogen
• nafamostat

Topics

• Aged
• Anticoagulants (pharmacology, therapeutic use)
• Benzamidines (pharmacology, therapeutic use)
• COVID-19 (blood, classification)
• Female
• Fibrin Fibrinogen Degradation Products (metabolism)
• Fibrinogen (drug effects, metabolism)
• Guanidines (pharmacology, therapeutic use)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• COVID-19 Drug Treatment