Viscoelastic hemostasis assays in septic, critically ill coronavirus disease 2019 patients: a practical guide for
Mansour Gergi1, Andrew Goodwin2, Kalev Freeman3
1Department of Medicine/Division of Hematology Oncology.
Insights
Viscoelastic hemostatic assays (VHA) can help identify unusual blood clotting in patients with Coronavirus disease 2019 (COVID-19). This guide aids clinicians in interpreting VHA results for better patient outcomes.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) is associated with a unique coagulopathy characterized by hypercoagulability and thrombotic complications.
- Conventional coagulation assays may not adequately detect COVID-19-associated coagulopathy, potentially leading to missed diagnoses and adverse outcomes.
- Viscoelastic hemostatic assays (VHA) offer a potential adjunctive tool for assessing hypercoagulability, though their role in sepsis and COVID-19 requires further definition.
Purpose of the Study:
- To provide a practical guide for clinicians on the utilization of Viscoelastic hemostatic assays (VHA) in patients with COVID-19.
- To review existing literature on VHA in sepsis and current knowledge of COVID-19-associated coagulopathy.
- To address the challenges clinicians face in interpreting VHA results in the context of COVID-19.
Main Methods:
- Literature review of VHA in sepsis.
- Review of current understanding of COVID-19-associated coagulopathy.
- Synthesis of findings to create a clinical interpretation guide.
Main Results:
- COVID-19-associated coagulopathy presents with significant hypercoagulability and evidence of fibrinolysis shutdown in VHA findings.
- VHA may offer a more comprehensive assessment of hemostatic derangements compared to conventional assays in COVID-19 patients.
- Existing literature suggests VHA can detect hypercoagulable states relevant to COVID-19, but large randomized trials are lacking.
Conclusions:
- Viscoelastic hemostatic assays (VHA) show promise in characterizing the hypercoagulable state seen in COVID-19.
- A practical guide is needed to assist clinicians in interpreting VHA results for effective management of COVID-19-associated coagulopathy.
- Further research, including randomized trials, is warranted to establish the definitive role of VHA in COVID-19 patient care.
Abstract:
Coronavirus disease 2019 (COVID-19)-associated coagulopathy is unusual, poorly defined and is linked with significant hypercoagulability and microthrombotic and macrothrombotic complications leading to worse outcomes and higher mortality. Conventional coagulation assays do not always actively reflect these derangements and might fail to detect this coagulopathy. Viscoelastic hemostatic assays (VHA) provide a possible tool that adds to conventional coagulation assays in identifying this hypercoagulable state. VHA has been mostly used in surgery and trauma but it's still not well defined in sepsis patients with lack of large randomized trials. Few studies described VHA findings in patients with COVID-19 showing significant hypercoagulability and fibrinolysis shutdown. Clinicians taking care of these patients might have little experience interpreting VHA results. By reviewing the available literature on the use of VHA in sepsis, and the current knowledge on COVID-19-associated coagulopathy we provide clinicians with a practical guide on VHA utilization in patients with COVID-19.
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