Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy?

Bull, Brian S.; Hay, Karen L.; Herrmann, Paul C.

doi:10.3390/jcm11082084

Open AccessArticle

Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy?

by

Brian S. Bull

,

Karen L. Hay

and

Paul C. Herrmann

^*

Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, CA 92354, USA

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2022, 11(8), 2084; https://doi.org/10.3390/jcm11082084

Submission received: 24 February 2022 / Revised: 25 March 2022 / Accepted: 4 April 2022 / Published: 7 April 2022

(This article belongs to the Special Issue Clinical Research on Viscoelastic Testing)

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Abstract

Viscoelastic testing (VET) by both TEG and ROTEM has demonstrated hypercoagulability early in corona virus disease 2019 (COVID-19) associated coagulopathy (CAC). Additional VET studies demonstrated fibrinolytic shutdown late in a majority of severely ill COVID-19 patients with an associated elevation of d-dimer. Elevated d-dimer confirms that coagulation, followed by fibrinolysis, has occurred. These findings imply that, during CAC, three enzymes—thrombin, Factor XIIIa and plasmin—must have acted in sequence. However, limitations in standard VET analyses preclude exploration of the earliest phases of clot induction, as well as clot formation and clot dissolution in flowing blood. Herein, we describe a novel method illuminating aspects of this unexplored area. In addition, we created an in vitro blood flow model in which the interactions of thrombin, Factor XIII and plasmin with fibrinogen can be studied, allowing the determination of soluble fibrin (SF), the highly unstable form of fibrin that precedes the appearance of a visible clot. This model allows the determination of the SF level at which fibrin microclots begin to form.

Keywords: COVID-19; fibrin; fibrinogen; fibrinolysis; fibrinolytic shutdown; rotational thromboelastometry (ROTEM); soluble fibrin monomer complex (SFMC); thromboelastography (TEG); thrombosis; viscoelastic

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MDPI and ACS Style

Bull, B.S.; Hay, K.L.; Herrmann, P.C. Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy? J. Clin. Med. 2022, 11, 2084. https://doi.org/10.3390/jcm11082084

AMA Style

Bull BS, Hay KL, Herrmann PC. Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy? Journal of Clinical Medicine. 2022; 11(8):2084. https://doi.org/10.3390/jcm11082084

Chicago/Turabian Style

Bull, Brian S., Karen L. Hay, and Paul C. Herrmann. 2022. "Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy?" Journal of Clinical Medicine 11, no. 8: 2084. https://doi.org/10.3390/jcm11082084

APA Style

Bull, B. S., Hay, K. L., & Herrmann, P. C. (2022). Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy? Journal of Clinical Medicine, 11(8), 2084. https://doi.org/10.3390/jcm11082084

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy?

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