id	author	title	date	pages	extension	mime	words	sentences	flesch	summary	cache	txt
cord-293473-32jx8j5g	Maier, Cheryl L.	Falsely Low Fibrinogen Levels in COVID-19 Patients on Direct Thrombin Inhibitors	2020-05-12		.txt	text/plain	823	56	41	When present in the patient sample, DTIs inhibit the thrombin in the Clauss reagent, prolonging the time to clot formation, and thus underestimating the fibrinogen concentration. Viscoelastic testing represents an alternative to the Clauss method for following fibrinogen levels in the setting of DTIs. The platelet-fibrinogen interactions assessed by maximum amplitude on thromboelastography (TEG) (Haemonetics, Boston, MA) or maximum clot formation on rotational thromboelastometry (ROTEM) (Instrumentation Laboratories) are relatively unaffected by the presence of DTIs. 6 In the example provided in the Figure, a ROTEM was obtained following the reported severe drop in fibrinogen on day 4 and resulted in the following notable parameters: EXTEM clotting time of 477 seconds (normal range 43-82 seconds) and FIBTEM maximum clot firmness of 39 mm (normal range 7-24 mm). The graph demonstrates an example of the magnitude of which an argatroban infusion can have upon the measurement of fibrinogen levels determined by the Clauss assay.	./cache/cord-293473-32jx8j5g.txt	./txt/cord-293473-32jx8j5g.txt