tetano
Editor, Senior Moderator
Res Pract Thromb Haemost
. 2022 Jan 15;6(1):e12645.
doi: 10.1002/rth2.12645. eCollection 2022 Jan.
Thromboelastography determined dynamics of blood coagulation and its correlation with complications and outcomes in patients with coronavirus disease 2019
Tushar Sehgal[SUP] 1 [/SUP], Mukul Aggarwal[SUP] 2 [/SUP], Upendra Baitha[SUP] 3 [/SUP], Gaurav Gupta[SUP] 3 [/SUP], Bindu Prakash[SUP] 3 [/SUP], Anu Gupta[SUP] 4 [/SUP], Ganesh Kumar[SUP] 2 [/SUP], Ashutosh Biswas[SUP] 3 [/SUP], Maroof Khan[SUP] 5 [/SUP], Shalimar[SUP] 6 [/SUP]
Affiliations
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.
Keywords: COVID‐19; coagulopathy; hypercoagulable; outcome; thromboelastography.
. 2022 Jan 15;6(1):e12645.
doi: 10.1002/rth2.12645. eCollection 2022 Jan.
Thromboelastography determined dynamics of blood coagulation and its correlation with complications and outcomes in patients with coronavirus disease 2019
Tushar Sehgal[SUP] 1 [/SUP], Mukul Aggarwal[SUP] 2 [/SUP], Upendra Baitha[SUP] 3 [/SUP], Gaurav Gupta[SUP] 3 [/SUP], Bindu Prakash[SUP] 3 [/SUP], Anu Gupta[SUP] 4 [/SUP], Ganesh Kumar[SUP] 2 [/SUP], Ashutosh Biswas[SUP] 3 [/SUP], Maroof Khan[SUP] 5 [/SUP], Shalimar[SUP] 6 [/SUP]
Affiliations
- PMID: 35071969
- PMCID: PMC8760607
- DOI: 10.1002/rth2.12645
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.
Keywords: COVID‐19; coagulopathy; hypercoagulable; outcome; thromboelastography.