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Updated: Oct 5, 2025
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Thromboelastography determined dynamics of blood coagulation and its correlation with complications and outcomes in
Tushar Sehgal1, Mukul Aggarwal2, Upendra Baitha3
1Department of Laboratory Medicine All India Institute of Medical Sciences New Delhi India.
Insights
COVID-19 causes coagulopathy, with thromboelastography (TEG) revealing hypercoagulable states in most patients. These abnormalities, along with severe inflammation, predict poor outcomes, highlighting TEG
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 is associated with hemostatic system abnormalities, termed COVID-associated coagulopathy.
- Whole-blood viscoelastic tests like thromboelastography (TEG) are crucial for understanding clot formation dynamics.
- This study investigated TEG abnormalities and their correlation with clinical outcomes in COVID-19 patients.
Purpose of the Study:
- To assess the spectrum of TEG abnormalities in COVID-19 patients.
- To identify predictors of clinical outcomes using TEG parameters.
- To compare TEG findings with conventional coagulation tests.
Main Methods:
- Thromboelastography (TEG) was performed on 28 COVID-19 patients.
- Patients' hemostatic conditions were classified as hypercoagulable, hypocoagulable, or normal based on TEG variables.
- Laboratory parameters and clinical outcomes were compared between hypercoagulable and normal groups.
Main Results:
- Of 28 patients, 63% exhibited hypercoagulable states, 7% hypocoagulable, and 30% normal coagulation.
- Severe COVID-19 was prevalent (70.4%), often accompanied by elevated C-reactive protein and ferritin.
- Twenty-eight-day mortality was significantly higher in patients with hypercoagulable or hypocoagulable states compared to those with normal coagulation (P=.002).
Conclusions:
- A hypercoagulable state is common in COVID-19 patients, even with thromboprophylaxis, and is linked to severe inflammation.
- TEG provides a more comprehensive assessment of coagulation status than conventional tests.
- Coagulation abnormalities identified by TEG are associated with adverse clinical outcomes in COVID-19.
Background:
Coronavirus disease 2019 (COVID-19) causes abnormalities in the hemostatic system, collectively known as COVID-associated coagulopathy. The dynamics of clot formation are best discerned by whole-blood viscoelastic tests, such as thromboelastography (TEG). We aimed to assess the various abnormalities seen on TEG and explored the predictors of outcomes in these patients.
Methods:
Thromboelastography was performed for 28 patients with COVID-19 using an automated thromboelastogram. The hemostatic condition was categorized as hypercoagulable in 17 (63%), hypocoagulable in 2 (7%), and normal in 8 (30%) based on TEG variables, such as reaction time , time until clot reaches a fixed strength, alpha angle, maximum amplitude, and clotting index. Laboratory parameters and clinical outcomes were compared between hypercoagulable and normal groups.
Results:
Twenty-seven patients with a median age of 50 years (interquartile range, 40-60 years), male-to-female ratio of 0.9:1, median C-reactive protein of 25.7 (10.9-108.8) mg/L, serum ferritin of 693 (317-1031) µg/L, and albumin 2.9 (2.6-3.3) g/dL were included. The median prothrombin time/international normalized ratio and activated partial thromboplastin time were within normal range in the hypercoagulable and normal groups. The severity of COVID-19 was mild in 6 (22.2%), moderate in 2 (7.4%), and severe in 19 (70.4%) patients. Twenty-eight-day mortality among patients with hypocoagulable and hypercoagulable states was higher than normal coagulation status. (log-rank test, P = .002).
Conclusions:
Hypercoagulable state, together with a severe inflammatory state, is common in patients with COVID-19, despite thromboprophylaxis. TEG assesses coagulation status better than conventional coagulation tests. Coagulation abnormalities are associated with poor outcomes.
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