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

Abstract

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.

Relative Hypercoagulopathy of the SARS-CoV-2 Beta and Delta Variants when Compared to the Less Severe Omicron Variants Is Related to TEG Parameters, the Extent of Fibrin Amyloid Microclots, and the Severity of Clinical Illness

“…A large proportion of critically ill COVID-19 patients will present with hypercoagulable TEG profiles. 45 71 72 Omicron patients are met with reduced odds of developing severe disease, 73 leading to the assumption of less hypercoagulable TEG profiles. The results presented here do indeed indicate lesser hypercoagulability in our omicron population when compared with healthy individuals versus our β/Δ population when compared with the same set of healthy individuals.…”

Relative hypercoagulopathy of the SARS-CoV-2 Beta and Delta variants when compared to the less severe Omicron variants is related to TEG parameters, the extent of fibrin amyloid microclots, and the severity of clinical illness.

“…In this study, we demonstrated TEG® results and their ability to distinguish differing degrees of hypercoagulability among the variants. A large proportion of critically ill COVID-19 patients will present with hypercoagulable TEG® pro les 45,71,72 . Omicron patients are met with reduced odds of developing severe disease 73 , leading to the assumption of less hypercoagulable TEG® pro les.…”