Comparison of the New Viscoelastic Coagulation Analyzer ClotPro® With ROTEM® Delta and Conventional Coagulation Tests in Critically Ill Patients With COVID-19

Abstract

Background: Viscoelastic coagulation testing has been suggested to help manage coagulopathy in critically ill patients with COVID-19. However, results from different viscoelastic devices are not readily comparable. ClotPro® is a novel thromboelastometry analyzer offering a wider range of commercially available assays.Methods: We compared the results from ClotPro with results from the well-established ROTEM® Delta device and conventional coagulation tests in critically ill patients with COVID-19.Results: Viscoelastic parameters indicated the presence of a potentially hypercoagulable state in the majority of patients. In up to 95 paired measurements, we found strong correlations between several parameters routinely used in clinical practice: (i) EX test vs. EXTEM CT, A5, A10, MCF, (ii) IN test vs. INTEM A5, A10, MCF, and (iii) FIB test vs. FIBTEM A5, A10, MCF (all R > 0.7 and p < 0.001). In contrast, IN test CT vs. INTEM CT showed only a moderate correlation (R = 0.53 and p < 0.001). Clot strength parameters of both devices exhibited strong correlations with platelet counts and fibrinogen levels (all R > 0.7 and p < 0.001). Divergent correlations of intrinsically activated assays with aPTT and anti-factor Xa activity were visible. Regarding absolute differences of test results, considerable delta occurred in CT, CFT, and clot strength parameters (all p < 0.001) between both devices.Conclusions: Several parameters obtained by ClotPro show strong correlations with ROTEM Delta. Due to weak correlations of intrinsically activated clotting times and considerable absolute differences in a number of parameters, our findings underline the need for device-specific algorithms in this patient cohort.

Predictive ability of viscoelastic testing using ClotPro® for short-term outcome in patients with severe Covid-19 ARDS with or without ECMO therapy: a retrospective study

“…In this study ClotPro® parameters were compared to ROTEM® Delta parameters and conventional laboratory assays, TPA-test was not performed. Compared to our study, hypercoagulability at baseline was nearly similar (median MCF in EX-test of 68 mm in our study to median of 68.5 mm (Bachler et al [ 40 ]) and mean of 70 mm (Infanger et al [ 48 ]). However, considerable discrepancies were found with regard to the effect of anticoagulants or deficiency of coagulation factors.…”

“…However, considerable discrepancies were found with regard to the effect of anticoagulants or deficiency of coagulation factors. For instance, median CT in EX-test was 82 s in our study cohort but only 51.5 s (Bachler et al [ 40 ]) or 77 s (Infanger et al [ 48 ]), respectively. In addition, median CT in IN-test was 304 s at baseline in our study compared to 188 s (Bachler et al [ 40 ]) and 165 s (Infanger et al [ 48 ]), respectively.…”

“…This group also evaluated hypercoagulability and fibrinolysis using a newly developed TPA-test. Infanger et al investigated 27 more severe COVID-19 patients (mean SOFA score 11 points), often requiring mechanical ventilation but without ECMO-support [ 48 ]. In this study ClotPro® parameters were compared to ROTEM® Delta parameters and conventional laboratory assays, TPA-test was not performed.…”

The evolution of clot strength in critically ill COVID-19 patients: a prospective observational thromboelastography study

“… Influence of medications like antiplatelets and antifibrinolytics on TEG profile is not clear from the study. Methodology : Baseline values of TEG may be different for different populations [ 7 ] and these values may also vary for different TEG machines [ 8 ] as has been seen in a recent study in COVID-19. Disposal of COVID-19 positive blood and disinfection of TEG machine would also be prudent to know for the readers interested in replicating similar studies.…”

“…Baseline values of TEG may be different for different populations [ 7 ] and these values may also vary for different TEG machines [ 8 ] as has been seen in a recent study in COVID-19.…”