Screening of COVID-19-associated hypercoagulopathy using rotational thromboelastometry

Iwasaki, Yudai; Shiga, Takuya; Konno, Daisuke; Saito, Koji; Aoyagi, Tetsuji; Oshima, Kengo; Kanamori, Hajime; Baba, Hiroaki; Tokuda, Koichi; Yamauchi, M.

doi:10.1016/j.jclinane.2020.109976

Cited by 6 publications

(37 citation statements)

References 4 publications

(4 reference statements)

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“…27 All the observational clinical studies described point to the use of VET to assess hypercoagulability and hypofibrinolysis (not detected by SCT), and probably also for anticoagulation monitoring. 1,2,10,27,32,33,35,[38][39][40][41][42] Improvements on VET parameters and patients` clinical status were observed after introduction of tailored thromboprophylaxis. 1,2,30,32,44 The use of TEG ® or ROTEM ® is recommended by some authors 18 and advised by others 2,4,10,23,27,32,38 for all COVID-19 patients with severe pneumonia and coagulation dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…2,27,30,31 ROTEM ® is the most used device to assess CAC. Initially, two clinical cases 32,33 with severe COVID-19 acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) were described. Both revealed normal PT and APTT, very increased D-dimer and fibrinogen levels, and a HS on ROTEM ® (increased MCF-EXTEM/INTEM/FIBTEM, 32,33 elevated α angle-EXTEM, 33 and decreased CFT-EXTEM 32 /CFT-FIBTEM), 33 and therefore a higher dose of unfractionated heparin (UFH) was started.…”

Section: Clinical Trialsmentioning

confidence: 99%

“…Both revealed normal PT and APTT, very increased D-dimer and fibrinogen levels, and a HS on ROTEM ® (increased MCF-EXTEM/INTEM/FIBTEM, 32,33 elevated α angle-EXTEM, 33 and decreased CFT-EXTEM 32 /CFT-FIBTEM), 33 and therefore a higher dose of unfractionated heparin (UFH) was started. 32,33 No thromboembolic (TE) or hemorrhagic events (HE) were observed and D-dimers have decreased. 32 The authors suggested that VET may have a role in rapidly identifying severe COVID-19 in critically ill patients with hypercoagulability, 32 not detected with SCT, 33 and that robust anticoagulation might be needed to prevent TE.…”

Section: Clinical Trialsmentioning

confidence: 99%

“…32,33 No thromboembolic (TE) or hemorrhagic events (HE) were observed and D-dimers have decreased. 32 The authors suggested that VET may have a role in rapidly identifying severe COVID-19 in critically ill patients with hypercoagulability, 32 not detected with SCT, 33 and that robust anticoagulation might be needed to prevent TE. 32,33 A study by Spieza et al 30 included 22 patients admitted to the ICU and showed evidence of hypercoagulability on ROTEM ® with a shorter CFT and high clot firmness (MCF).…”

Section: Clinical Trialsmentioning

confidence: 99%

“…32 The authors suggested that VET may have a role in rapidly identifying severe COVID-19 in critically ill patients with hypercoagulability, 32 not detected with SCT, 33 and that robust anticoagulation might be needed to prevent TE. 32,33 A study by Spieza et al 30 included 22 patients admitted to the ICU and showed evidence of hypercoagulability on ROTEM ® with a shorter CFT and high clot firmness (MCF). 11,30 Compared with healthy controls, the following results were observed 30 : (a) significantly higher fibrinogen and D-dimer levels (p < 0.0001); (b) markedly hypercoagulability on ROTEM ® : shorter CFT-INTEM (p = 0.0002) and CFT-EXTEM (p = 0.01), and higher MCF in INTEM/EXTEM/FIBTEM (p < 0.001).…”

Section: Clinical Trialsmentioning

confidence: 99%

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Viscoelastic Tests in the Evaluation of Haemostasis Disturbances in SARS-CoV2 Infection

et al. 2021

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COVID-19 associated coagulopathy is a dysfunction of severe SARS-CoV-2 infection, characterized by significantly increased fibrinogen, D-dimer and C reactive protein and normal to near-normal prothrombin time, activated partial thromboplastin time and platelet count. Hypercoagulopathy and hypofibrinolysis coexist and are detected by viscoelastic tests. These features, when associated with immobilization and intrinsic risk factors (age, obesity, comorbidities, drugs) of the patient, can trigger thromboembolic events, despite thromboprophylaxis. The lungs are the first and most severely damaged organ. To date, most patients have exhibited hypercoagulability on viscoelastic tests not detected by standard coagulation tests. A high rate of thrombotic events was reported, suggesting that it should be considered as a cause of clinical deterioration in intensive care and potentially other clinical settings. In advanced stage, COVID-19 associated coagulopathy, fibrinogen and platelet count can decrease significantly, depending on the severity of clinical status resembling consumptive coagulopathy. In this stage, bleeding events can occur, especially if the patient is under extracorporeal membrane oxygenation (ECMO). Viscoelastic tests are very useful tools to assess hypercoagulability and hypofibrinolysis (not detectable by standard coagulation tests) in critically ill SARS-CoV-2 patients with COVID-19 associated coagulopathy and look like very promising tools for anticoagulation management. However, further research needs to be carried out to determine whether abnormal viscoelastic tests alone or in combination with other clinical or laboratory findings can identify patients at increased thrombotic risk. Clinical trials to evaluate hypercoagulability using viscoelastic tests and the need for personalized dosage of anticoagulation in SARS-CoV-2 patientsare quickly emerging.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Trialsmentioning

confidence: 99%

Section: Clinical Trialsmentioning

confidence: 99%

Section: Clinical Trialsmentioning

confidence: 99%

Section: Clinical Trialsmentioning

confidence: 99%

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Viscoelastic Tests in the Evaluation of Haemostasis Disturbances in SARS-CoV2 Infection

et al. 2021

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Investigation of differences in coagulation characteristics between hospitalized patients with SARS‐CoV‐2 Alpha, Delta, and Omicron variant infection using rotational thromboelastometry (ROTEM): A single‐center, retrospective, observational study

Matsuoka

Koami

Shinada

et al. 2022

Clinical Laboratory Analysis

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Background The severe acute respiratory syndrome coronavirus 2 Omicron variant has a low rate of serious illness, is highly contagious, and has spread rapidly since January 2022. The number of severe cases and deaths remains problematic. Here, we aimed to elucidate the coagulation pathology of Omicron‐infected patients using rotational thromboelastometry. Methods Patients with coronavirus disease 2019, hospitalized and treated from January 2021 to April 2022, were included. The Alpha–Delta and Omicron groups were defined during admission. Blood tests, clinical course, and rotational thromboelastometry measurements were compared using a propensity score‐matched cohort. Results Both groups had 21 patients each. Lactate dehydrogenase (Alpha–Delta group [interquartile range] vs. Omicron group [interquartile range]; 449 [368–518] U/L vs. 241 [196–398] U/L, p = 0.01) and ferritin (1428 [1145–3061] ng/dl vs. 481 [188–881] ng/dl, p = 0.0002) levels were significantly lower in the Omicron group. In rotational thromboelastometry, the thrombus hardness indexes FIBTEM A5 (29 [23–34] mm vs. 23 [18–28] mm, p = 0.034) and maximum clot firmness (34 [27–40] mm vs. 26 [21–33] mm, p = 0.021) were significantly lower in the Omicron group, whereas the fibrinolysis index FIBTEM LI60 (98 [92–100] % vs. 100 [100–100] %, p = 0.0082) was higher. Conclusion Severe coagulation abnormalities may be less likely in Omicron‐infected patients than in those infected with the previous Alpha and Delta variants.

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COVID-19 and Hypercoagulability: A Review

Kichloo

Dettloff

Aljadah

et al. 2020

Clin Appl Thromb Hemost

134

109

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Thrombotic complications of the novel coronavirus (COVID-19) are a concerning aspect of the disease, due to the high incidence in critically ill patients and poor clinical outcomes. COVID-19 predisposes patients to a hypercoagulable state, however, the pathophysiology behind the thrombotic complications seen in this disease is not well understood. Several mechanisms have been proposed and the pathogenesis likely involves a host immune response contributing to vascular endothelial cell injury, inflammation, activation of the coagulation cascade via tissue factor expression, and shutdown of fibrinolysis. Treatments targeting these pathways may need to be considered to improve clinical outcomes and decrease overall mortality due to thrombotic complications. In this review, we will discuss the proposed pathophysiologic mechanisms for thrombotic complications in COVID-19, as well as treatment strategies for these complications based on the current literature available.

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Screening of COVID-19-associated hypercoagulopathy using rotational thromboelastometry

Cited by 6 publications

References 4 publications

Viscoelastic Tests in the Evaluation of Haemostasis Disturbances in SARS-CoV2 Infection

Viscoelastic Tests in the Evaluation of Haemostasis Disturbances in SARS-CoV2 Infection

Investigation of differences in coagulation characteristics between hospitalized patients with SARS‐CoV‐2 Alpha, Delta, and Omicron variant infection using rotational thromboelastometry (ROTEM): A single‐center, retrospective, observational study

COVID-19 and Hypercoagulability: A Review

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