Studies on hemostasis in COVID‐19 deserve careful reporting of the laboratory methods, their significance, and their limitations

Hardy, Michaël; Douxfils, Jonathan; Bareille, Marion; Lessire, Sarah; Gouin‐Thibault, Isabelle; Fontana, Pierre; Lecompte, T.; Mullier, François

doi:10.1111/jth.15061

Cited by 17 publications

(30 citation statements)

References 10 publications

(18 reference statements)

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“…80 Many preanalytical and analytical factors can influence the results of TEG and TEM and these factors should be included in research methodology concerning the usefulness of these methods in COVID-19. 78,80 VEMs are also performed with fresh blood and the method's cost is relatively high; therefore, it is possible that non-whole blood assays might have advantages in comparison to these laboratory techniques.…”

Section: Discussionmentioning

confidence: 99%

Hemostasis in Coronavirus Disease 2019—Lesson from Viscoelastic Methods: A Systematic Review

2021

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Haemostatic unbalance is often observed in patients with coronavirus disease 2019 (COVID-19), and patients with severe disease are at high risk of developing thromboembolic complications. Viscoelastic methods (VEMs), including thrombelastography (TEG) and thromboelastometry (TEM), provide data on the nature of haemostatic disturbance. In this systematic review, we assessed the performance of TEG and TEM in the assessment of blood coagulation and fibrinolysis in patients with COVID-19. PubMed, Scopus, Web of Science Core Collection, medRxiv and bioRxiv were systematically searched for clinical studies evaluating TEG and/or TEM variables in COVID-19 individuals. Ten studies, with a total of 389 COVID-19 patients, were included, and VEMs were performed in 292 of these patients. Most patients (90%) presented severe COVID-19 and required mechanical ventilation. TEG and TEM variables showed that these patients displayed hypercoagulability and fibrinolysis shutdown, despite the use of appropriate thromboprophylaxis. However, the mechanism underlying these phenomena and their clinical significance in COVID-19 patients who developed thrombosis, is still not clear. Further studies are warranted if VEMs might help to identify those at highest risk of thrombotic events and who therefore may derive the greatest benefit from antithrombotic therapy.

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Section: Discussionmentioning

confidence: 99%

Hemostasis in Coronavirus Disease 2019—Lesson from Viscoelastic Methods: A Systematic Review

2021

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“…We believe that despite several studies addressing the alterations in the coagulation system of COVID-19 patients, [41][42][43][44][45][46] our study continues to bring important news because it was one of the few that evaluated the behavior of the coagulation system, of critically critical patients infected with COVID-19, during two weeks of hospitalization. Also, our study was one of the few where we tried to assess the impact of the degree of change in the coagulation system and its impact on the evolution of organ dysfunctions presented by patients during the two weeks of study.…”

Section: Plos Onementioning

confidence: 99%

Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study

et al. 2020

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Background Coagulation abnormalities in COVID-19 patients have not been addressed in depth. Objective To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19. Methods Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10. Results Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM–FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability. Conclusion COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.

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“…In many cases, laboratory coagulation tests alone do not appear to be sensitive and/or clinically meaningful enough to detect coagulation and predict clinical outcomes [ 7 ], and can be variable between different demographic patient groups with unclear clinical interpretation [ 8 ]. The performance of D-dimer assays in patients with COVID-19 is highly variable, making it difficult to compare results from studies using different assays and to determine a standard cut-off threshold [ 9 ]. Therefore, measurements of conventional coagulation parameters cannot be considered standard of care for the diagnosis or management of COVID-19-associated coagulopathy.…”

Section: Introductionmentioning

confidence: 99%

The Role of TEG Analysis in Patients with COVID-19-Associated Coagulopathy: A Systematic Review

et al. 2021

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Coronavirus disease 2019 (COVID-19)-associated coagulopathy (CAC), characterized by hypercoagulability and an increased risk of thrombotic complications, is an important consideration in the management of patients with COVID-19. As COVID-19 is a new disease, no standard of care for the diagnosis or management of its associated coagulopathy is yet established. Whole blood viscoelastic tests, such as thromboelastography (TEG® hemostasis analyzer), analyze whole blood to provide a complete overview of the coagulation status. We conducted a systematic review of thromboelastography for management of patients with COVID-19, using MEDLINE (PubMed) and Cochrane databases. TEG® parameter measurements and clinical outcomes data were extracted for analysis. Our review found 15 publications, with overall results showing thromboelastography can identify and assess a hypercoagulable state in patients with COVID-19. Furthermore, utilization of thromboelastography in this patient population was shown to predict thrombotic complications. The benefits of thromboelastography presented here, in addition to advantages compared with laboratory coagulation tests, position thromboelastography as an important opportunity for optimizing diagnosis of CAC and improving patient management in COVID-19. Given that the benefits of thromboelastography have already been demonstrated in several other clinical applications, we anticipate that clinical data from future studies in patients with COVID-19 will further elucidate the optimal use of thromboelastography in this patient population.

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Studies on hemostasis in COVID‐19 deserve careful reporting of the laboratory methods, their significance, and their limitations

Abstract: Low tissue factor pathway inhibitor (TFPI) together with low antithrombin allows sufficient thrombin generation in neonates.

Cited by 17 publications

References 10 publications

Hemostasis in Coronavirus Disease 2019—Lesson from Viscoelastic Methods: A Systematic Review

Hemostasis in Coronavirus Disease 2019—Lesson from Viscoelastic Methods: A Systematic Review

Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study

The Role of TEG Analysis in Patients with COVID-19-Associated Coagulopathy: A Systematic Review

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