Viscoelastic hemostasis assays in septic, critically ill coronavirus disease 2019 patients: a practical guide for clinicians

Gergi, Mansour; Goodwin, Andrew; Freeman, Kalev; Colovos, Christos; Volod, Oksana

doi:10.1097/mbc.0000000000000999

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…The COVID-19 pandemic has elevated the need for rapid POC testing to gauge the COVID-19 patient's hemostatic competence, thus ushering in accelerated utilization of the VHAs to diagnose and treat patients with CAC [23,134,135,150,151,153,165,166]. The hypercoagulopathy of CAC inversely mirrors the hypocoagulopathy of many other areas of clinical medicine where hypocoagulopathies can quickly evolve in the medical and surgical intensive care units, obstetrical units, and operating theaters.…”

Section: Discussionmentioning

confidence: 99%

“…The addition of heparinase to one of the cups allows the VHA assays to quantify the heparin affect, and these assays are therefore used frequently in liver transplantation and cardiac surgery. Most recently, they have been used to monitor ECMO patients, as well as heparinized COVID-19 patients [36,114,[133][134][135][136]. The assessment of non-thrombin-based platelet activation/inhibition can be assayed using TEG/PM ® and Multiplate ® , which is often used in concert with ROTEM ® .…”

Section: Vhas Reflecting Anticoagulationmentioning

confidence: 99%

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Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Volod

Bunch

Zackariya

et al. 2022

JCM

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Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG® 5000) and rotational thromboelastometry (ROTEM® delta), have been supplanted not only by cartridge systems (TEG® 6S and ROTEM® sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot®, Quantra®, and ClotPro®). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Vhas Reflecting Anticoagulationmentioning

confidence: 99%

Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Volod

Bunch

Zackariya

et al. 2022

JCM

Self Cite

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“…3,4 VET analysis has also been proposed as a powerful tool for the study of the global hemostatic status of COVID-19 patients. 25 Especially, these studies have focused on the analysis of patients with poor prognosis such as those admitted to the ICU or with ARDS, revealing that VET analysis could be established as a promising tool to predict thrombotic complications and thus optimize the diagnosis and treatment of COVID-19 patients. 26 Our results showed that a high percentage of patients had altered parameters of clot stiffness, mainly due to the contribution of fibrinogen.…”

Section: Discussionmentioning

confidence: 99%

Clot Stiffness Measured By Seer Sonorheometry As a Marker Of Poor Prognosis In Hospitalized COVID-19 Patients

López-Jaime

Bello

Martin-Tellez

et al. 2022

Clin Appl Thromb Hemost

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A high risk of thrombotic complications has been observed among severely ill COVID-19 patients. Viscoelastic tests (VET) have shown a hypercoagulable profile in these patients, although so far there is no clear evidence on the use of these tools as predictors of risk in the clinical course of patients. In this study we aimed to evaluate the association between Quantra® sonorheometry VET parameters, standard coagulation tests and inflammatory markers in 69 patients with COVID-19 on hospital admission with disease severity and outcome. Inflammatory markers were elevated in a high percentage of patients, as were coagulation-related parameters such as fibrinogen and D-dimer levels. Quantra® sonorheometry analysis revealed increased clot stiffness (CS), especially due to increased fibrinogen contribution (FCS) in 63.7%. Analysis of clot stability to lysis (CSL) on the Quantra showed a value of 100%, suggesting hypofibrinolysis, in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased CS and CSL were significantly associated with worsening disease. The combination of elevated FCS and D-dimer values showed a particularly high prognostic value in distinguishing patients with severe symptomatology. In conclusion, FCS measured by Quantra® system and its combination with D-dimer could be established as a powerful tool to identify poor prognosis in COVID-19 patients on hospital admission.

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“…VET analysis has also been proposed as a powerful tool for the study of the global hemostatic status of COVID-19 patients [24]. Especially, these studies have focused on the analysis of patients with poor prognosis such as those admitted to the ICU or with ARDS, revealing that VET analysis could be established as a promising tool to predict thrombotic complications and thus optimize the diagnosis and treatment of COVID-19 patients [25].…”

Section: Discussionmentioning

confidence: 99%

Clot Stiffness Measured by Seer Sonorheometry as a Marker of Poor Prognosis in Hospitalized Covid-19 Patients

López-Jaime

Martin-Tellez

Doblas-Marquez

et al. 2021

Preprint

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Background: High incidence of life-threatening thrombotic complications is observed in severely ill COVID-19 patients. D-dimer may help evaluate disease severity and predict outcomes at hospital admission. However, its non-specificity and long analysis times strongly constrain its clinical value. Viscoelastic tests (VET) are widely available rapid point-of-care devices that have been shown to detect a hypercoagulable state (increased clot stiffness and fibrinolysis shutdown) as major contributors of the thrombotic complication in COVID-19. Nevertheless, based on the data obtained so far, definitive conclusions have not been drawn. Objectives: We aim to evaluate the association between VET parameters, standard coagulation tests and inflammation markers assessed in COVID-19 patients at hospital admission with disease severity and outcomes. Patients/Methods: A total of 69 COVID-19 patients requiring hospitalization were included in the study. The pro-inflammatory and pro-thrombotic state was analyzed by a panel of inflammation markers (IL-6, CRP, LDH, ferritin), routine coagulation tests (PT, aPTT, platelet count, fibrinogen, D-dimer) and a SEER sonorheometry VET profile (Quantra System). Results: Inflammatory markers IL-6, CRP, LDH and ferritin were elevated in a high percentage of patients (73.6%, 89.2%, 57.1% and 52.4%), as were coagulation-related parameters such as fibrinogen (81.4%) and D-dimer levels (66.2%). Quantra analysis revealed increased clot stiffness (CS) in 34.8%, particularly due to increased fibrinogen contribution (FCS) in 63.7%. Increased clot stability to lysis (CSL) was observed in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased clot stiffness and resistance to clot lysis were significantly associated with worsening disease. The Quantra FCS parameter showed a particularly high prognostic value in distinguishing patients with severe symptomatology. Conclusion: The global study of hemostasis by the whole blood point-of-care Quantra VET system may be a powerful tool for identifying poor prognosis in COVID-19 patients at hospital admission. In particular, FCS measured by Quantra could be established as a plausible prognostic marker to aid the clinical management of COVID-19 patients.

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Viscoelastic hemostasis assays in septic, critically ill coronavirus disease 2019 patients: a practical guide for clinicians

Cited by 8 publications

References 28 publications

Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Clot Stiffness Measured By Seer Sonorheometry As a Marker Of Poor Prognosis In Hospitalized COVID-19 Patients

Clot Stiffness Measured by Seer Sonorheometry as a Marker of Poor Prognosis in Hospitalized Covid-19 Patients

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