Rotational thromboelastometry in critically ill COVID-19 patients does not predict thrombosis

Area of Science:

• Critical care medicine
• Hematology
• Infectious diseases

Background:

• Critically ill COVID-19 patients exhibit hypercoagulability, increasing thrombotic complication risk.
• Rotational thromboelastometry (ROTEM) is a viscoelastic test that may reflect this hypercoagulability.
• ROTEM's potential utility in predicting thrombosis in COVID-19 warrants investigation.

Purpose of the Study:

• To assess the predictive capability of ROTEM profiles for thrombotic complications in critically ill COVID-19 patients.
• To determine if ROTEM parameters can identify patients at high risk for arterial or venous thromboembolic events.

Main Methods:

• Retrospective multicenter cohort study of 113 adult COVID-19 ICU patients.
• ROTEM profiles (EXTEM, INTEM, FIBTEM) measured within 72 hours of ICU admission.
• Comparison of ROTEM parameters between patients with and without diagnosed thrombotic complications using logistic regression and ROC analysis.

Main Results:

• 23.9% of patients developed thrombotic events.
• EXTEM clot amplitude at 10 min (CA10) and maximum clot formation (MCF) showed trends towards association with thrombosis (p<0.2).
• ROC analysis revealed limited predictive power for EXTEM CA10 (AUC 0.58) and EXTEM MCF (AUC 0.60) for thrombosis.

Conclusions:

• ROTEM profiles obtained on ICU admission did not demonstrate significant potential to predict thrombotic complications in critically ill COVID-19 patients.
• Current ROTEM parameters evaluated are insufficient to differentiate risk stratification for thrombosis in this population.
• Further research may explore other ROTEM parameters or combinations for improved prediction.