Complex and prolonged hypercoagulability in coronavirus disease 2019 intensive care unit patients: A thromboelastographic study

Cordier, Pierre Yves; Pierrou, C.; Noel, Alexandre; Paris, Raphaël; Gaudray, Eliott; Martin, Edouard; Contargyris, Claire; Leger, Frédérik Bélot-De Saint; Lyochon, Arthur; Astier, Hélène; Desmots, F.; Savini, Hélène; Surcouf, Corinne

doi:10.1016/j.aucc.2020.11.007

Cited by 11 publications

(38 citation statements)

References 29 publications

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“…VETs were performed using ROTEM (25 studies), TEG (15 studies), Quantra (two prospective studies [66,67]) and ClotPro (one retrospective study [24] and one case report [68]); no study compared two devices. Among articles reporting data about TEG, four were prospective studies [52,[59][60][61], ten were retrospective studies [51,[53][54][55][56][57][58][62][63][64], and one was a case report [65]. Among articles dealing with ROTEM, thirteen were prospective studies [28][29][30][31][32][39][40][41][42][43][44][45][46], seven were retrospective studies [27,[33][34][35][36]48,49], one was a cross-sectional study [47], and four were case reports [26,37,38,50].…”

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

“…Testing was carried out either on admission or within the following days, but the timing of blood collection for VET was specified only for 29 studies [24,26,27,[29][30][31]33,[35][36][37][38]41,[43][44][45][46][47][48]50,53,[55][56][57][58][59][65][66][67]. In some studies, the measurements were repeated during the patientʹs stay, either because of a pre-established protocol [26,27,29,45,53,59,60,67] or because of the occurrence of a thromboembolic event [65,68]. Number of VETs performed during a patient's stay ranged from 1 to 5 [29].…”

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

“…Among the 15 TEG studies, two versions of the device were used: the TEG5000 (n = 7) [52][53][54][55][56][57][58] and the brand-new version TEG6s (n = 7) [59][60][61][62][63][64][65]. One article reported data without specification of the device [51].…”

Section: Tegmentioning

confidence: 99%

“…Kaolin TEG with heparinase (CKH) was the most used assay, as heparin is neutralized, and most patients received heparin. Among the 14 studies using this assay [51][52][53][54][55][56][57][58][59][60][62][63][64][65], an increase in maximum clot amplitude was reported, but this finding needs to be tempered for the following reasons. With patients' values higher than reference [51,54,57,58,60] or locally established [52,53,56] values, MA was considered abnormally increased, while in other studies MA was found at the upper limit of normal [59,62,64,65] or increased only in certain patients [55,63].…”

Section: Tegmentioning

confidence: 99%

“…Among the 14 studies using this assay [51][52][53][54][55][56][57][58][59][60][62][63][64][65], an increase in maximum clot amplitude was reported, but this finding needs to be tempered for the following reasons. With patients' values higher than reference [51,54,57,58,60] or locally established [52,53,56] values, MA was considered abnormally increased, while in other studies MA was found at the upper limit of normal [59,62,64,65] or increased only in certain patients [55,63]. For reaction time (R), 5 studies found decreased values from reference ranges [57] or from healthy volunteers [52,53,55,58], 4 reported decreased kinetics reaction K parameter as compared with healthy volunteers [52,53,55,58], and 11 reported increased α angle as compared with reference ranges (42,(45)(46)(47)(48)52,53) or healthy volunteers…”

Section: Tegmentioning

confidence: 99%

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Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Bareille

Hardy

Douxfils

et al. 2021

JCM

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Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

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Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

Section: Tegmentioning

confidence: 99%

Section: Tegmentioning

confidence: 99%

Section: Tegmentioning

confidence: 99%

See 3 more Smart Citations

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Bareille

Hardy

Douxfils

et al. 2021

JCM

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Thromboelastography determined dynamics of blood coagulation and its correlation with complications and outcomes in patients with coronavirus disease 2019

Sehgal

Aggarwal

Baitha

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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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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Point-of-Care Coagulation Tests in COVID-19

Baryshnikova

2021

The Coagulation Labyrinth of Covid-19

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Complex and prolonged hypercoagulability in coronavirus disease 2019 intensive care unit patients: A thromboelastographic study

Cited by 11 publications

References 29 publications

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Thromboelastography determined dynamics of blood coagulation and its correlation with complications and outcomes in patients with coronavirus disease 2019

Point-of-Care Coagulation Tests in COVID-19

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