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Published on: June 4, 2020
Assessment of Coagulation Profiles by Rotational Thromboelastometry in COVID 19 Patients
Insights
Viscoelastic tests like ROTEM reveal a hypercoagulable state in Coronavirus Disease-19 (COVID-19) patients, particularly severe cases. These tests aid in assessing COVID-19 coagulopathy and guiding thromboprophylactic management.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Thrombotic complications are common in Coronavirus Disease-19 (COVID-19), correlating with disease severity and poor outcomes.
- Conventional coagulation assays often fail to detect the hypercoagulable state in COVID-19 patients.
- The need for accurate assessment tools for COVID-19-associated coagulopathy is critical.
Purpose of the Study:
- To evaluate coagulation abnormalities in patients with varying severity of COVID-19.
- To assess the utility of viscoelastic tests in identifying hypercoagulable states in COVID-19.
- To compare viscoelastic test results with conventional coagulation assays.
Main Methods:
- A retrospective observational study involving 50 adult COVID-19 patients with moderate (20) and severe (30) pneumonia.
- Coagulation status assessed using rotational thromboelastometry (ROTEM®).
- ROTEM® results were analyzed alongside conventional assays: platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer.
Main Results:
- 88% of patients exhibited at least two hypercoagulable ROTEM parameters.
- Seven patients developed thromboembolic complications, all with severe COVID-19 pneumonia.
- Significant findings included decreased PT, increased fibrinogen and D-dimer, and shorter EXTEM CT, indicating a hypercoagulable state, especially in severe cases.
Conclusions:
- COVID-19 patients, particularly those with severe disease, demonstrate a hypercoagulable state.
- Viscoelastic testing (ROTEM®) is valuable for assessing COVID-19 coagulopathy.
- These findings support the potential use of viscoelastic tests in managing thromboprophylaxis for COVID-19 patients.
Background:
According to recent studies, thrombotic complications frequently occur in Coronavirus Disease-19 (COVID-19) and are associated with increasing disease severity and poor prognosis. However, conventional coagulation assays are unable to identify these patients' hypercoagulable states, raising questions about the appropriate assessment tool. We aimed to evaluate coagulation abnormalities in patients with different severity of CO-VID-19 using viscoelastic tests.
Methods:
This was a single center retrospective observational study in a group of 50 adult patients with SARS-COV-2 infection and different severity of pneumonia (20 moderate, 30 severe). Coagulation status was evaluated using rotational thromboelastometry (ROTEM®) in conjunction with conventional coagulation assays (platelet count, PT, aPTT, fibrinogen, and D-dimer levels).
Results:
Shorter than normal EXTEM CFT, higher than normal A10 and MCF in INTEM, EXTEM, and FIBTEM and higher than normal α-angle were classified as markers of hypercoagulable state. Forty-four (88%) patients had at least two hypercoagulable ROTEM parameters. Seven patients developed thromboembolic complications. All were classified as having severe COVID-19 pneumonia. With increment increases in disease severity, we observed an increase in the number of patients with hypercoagulable parameters and higher INTEM, EXTEM, and FIBTEM MCF but without being statistically significant. On the other hand, we noted a significant decrement of PT (p = 0.039), higher fibrinogen (p = 0.001), higher D dimer (p < 0.001), and shorter CT EXTEM (p < 0.001).
Conclusions:
Our findings support the presence of a hypercoagulable state in COVID-19 patients, especially in the severe forms. It also highlights the role of viscoelastic tests in assessing COVID-19 coagulopathy and, therefore, their potential use in thrombophrophylactic management.
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