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

Hartmann, Jan; Ergang, Alexis; Mason, Dan; Dias, João D.

doi:10.3390/diagnostics11020172

Cited by 52 publications

(92 citation statements)

References 48 publications

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“…Conclusions of the previously published reviews are summarized in Table 11. Overall, the four reviews reported the same findings as we do: COVID-19 patients displayed an abnormal VET pattern [69][70][71][72], but further studies are needed for various reasons. Moreover, we challenge the idea that such a pattern represents hypercoagulability; one main reason is that inhibitory systems are not at all taken into account, in sharp contrast with TGAs.…”

Section: Summary Of the Conclusion Of The Previously Published Reviewssupporting

confidence: 75%

“…There are numerous methodological differences among the 44 studies using VETs to assess the hemostasis in COVID-19 patients we have retrieved and analyzed, explaining why results were not consistent through studies, or sometimes even conflicting. This was already raised by previously published reviews [70,71].…”

Section: Methodological Issues In Vet Studiesmentioning

confidence: 82%

“…This raises questions that include (i) the effect of heparin, particularly at low doses, on VET results, (ii) whether heparinase or polybrene added to heparinized blood completely neutralized circulating heparin, and (iii) whether VETs can be used to guide heparin therapy. These questions were not raised by the previously published reviews [69][70][71][72].…”

Section: Impact Of Differences In Anticoagulation Regimens (Type (Ufhmentioning

confidence: 91%

“…Reviews have already been published recently, two of them only being systematic [69][70][71][72], but none has so far investigated the four major commercially available VET devices (i.e., ROTEM, TEG, ClotPro, and Quantra) or included such a large number of studies (n = 44). Characteristics of each review are summarized in Table 2.…”

Section: Originality Of Our Systematic Review As Compared To the Exismentioning

confidence: 99%

“…Overall, case reports were excluded (except for one systematic review [71]); few studies were available and presented extensive heterogeneity.…”

Section: Originality Of Our Systematic Review As Compared To the Exismentioning

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: Summary Of the Conclusion Of The Previously Published Reviewssupporting

confidence: 75%

Section: Methodological Issues In Vet Studiesmentioning

confidence: 82%

Section: Impact Of Differences In Anticoagulation Regimens (Type (Ufhmentioning

confidence: 91%

Section: Originality Of Our Systematic Review As Compared To the Exismentioning

confidence: 99%

“…Overall, case reports were excluded (except for one systematic review [71]); few studies were available and presented extensive heterogeneity.…”

Section: Originality Of Our Systematic Review As Compared To the Exismentioning

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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Comparative studies between humans and golden Syrian hamsters via thromboelastography

Yang,

Xie,

et al. 2024

Anim Models and Exp Med

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BackgroundThromboelastography (TEG) is a widely utilized clinical testing method for real‐time monitoring of platelet function and the thrombosis process. Lipid metabolism disorders are crucial risk factors for thrombosis. The lipid metabolism characteristics of hamsters resemble those of humans more closely than mice and rats, and their relatively large blood volume makes them suitable for studying the mechanisms of thrombosis related to plasma lipid mechanisms. Whole blood samples from golden Syrian hamsters and healthy humans were obtained following standard clinical procedures. TEG was employed to evaluate coagulation factor function, fibrinogen (Fib) function, platelet function, and the fibrinolytic system.MethodsThe whole blood from hamster or healthy human was isolated following the clinical procedure, and TEG was employed to evaluate the coagulation factor function, Fib function, platelet function, and fibrinolytic system. Coagulation analysis used ACLTOP750 automatic coagulation analysis pipeline. Blood routine testing used XN‐2000 automatic blood analyzer.ResultsTEG parameters revealed that hamsters exhibited stronger coagulation factor function than humans (reaction time [R], p = 0.0117), with stronger Fib function (alpha angle, p < 0.0001; K‐time [K], p < 0.0001). Platelet function did not differ significantly (maximum amplitude [MA], p = 0.077). Hamsters displayed higher coagulation status than humans (coagulation index [CI], p = 0.0023), and the rate of blood clot dissolution in hamsters differed from that in humans (percentage lysis 30 min after MA, p = 0.02). Coagulation analysis parameters indicated that prothrombin time (PT) and activated partial thromboplastin time (APTT) were faster in hamsters than in humans (PT, p = 0.0014; APTT, p = 0.03), whereas the Fib content was significantly lower in hamsters than in humans (p < 0.0001). No significant difference was observed in thrombin time (p = 0.1949).ConclusionsIn summary, TEG could be used to evaluate thrombosis and bleeding parameters in whole blood samples from hamsters. The platelet function of hamsters closely resembled that of humans, whereas their coagulation function was significantly stronger.

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Coagulation profiles and viscoelastic testing in multisystem inflammatory syndrome in children

Ankola

Bradford

Emani

et al. 2021

Pediatric Blood & Cancer

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Objective: To characterize viscoelastic testing profiles of children with multisystem inflammatory syndrome in children (MIS-C).Methods: This single-center retrospective review included 30 patients diagnosed with MIS-C from March 1 to September 1, 2020. Thromboelastography (TEG) with platelet mapping was performed in 19 (63%) patients and compared to age-and sex-matched controls prior to cardiac surgery. Relationships between TEG parameters and inflammatory markers were assessed using correlation.Results: Patients with MIS-C had abnormal TEG results compared to controls, including decreased kinetic (K) time (1.1 vs. 1.7 minutes, p < .01), increased alpha angle (75.0 • vs. 65.7 • , p < .01), increased maximum amplitude (70.8 vs. 58.3 mm, p < .01), and decreased lysis in 30 minutes (Ly30) (1.1% vs. 3.7%, p = .03); consistent with increased clot formation rate and strength, and reduced fibrinolysis. TEG maximum amplitude was moderately correlated with erythrocyte sedimentation rate (ESR) (r = 0.60, p = .02), initial platelet count (r = 0.67, p < .01), and peak platelet count (r = 0.51, p = .03). TEG alpha angle was moderately correlated with peak platelet count (r = 0.54, p = .02). Seventeen (57%) patients received aspirin (ASA) and anticoagulation, five (17%) received only ASA, and three (10%) received only anticoagulation. No patients had a symptomatic thrombotic event. Six (20%) patients had a bleeding event, none of which was major.Conclusions: Patients with MIS-C had evidence of hypercoagulability on TEG.Increased ESR and platelets were associated with higher clot strength. Patients were prophylactically treated with ASA or anticoagulation with no symptomatic thrombosis or major bleeding. Further multicenter study is required to characterize the rate of thrombosis and optimal thromboprophylaxis algorithm in this patient population.

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

Cited by 52 publications

References 48 publications

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

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

Comparative studies between humans and golden Syrian hamsters via thromboelastography

Coagulation profiles and viscoelastic testing in multisystem inflammatory syndrome in children

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