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.
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。.
Keywords: Anticoagulation therapy; Critical, COVID-2019, hypercoagulation status.