Hypercoagulation Detected by Rotational Thromboelastometry Predicts Mortality in COVID-19: A Risk Model Based on a Prospective Observational Study

Abstract

Background: Severe disease due to COVID-19 has been shown to be associated with hypercoagulation. The aim of this study was to assess Rotational Thromboelastometry (ROTEM®) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods: This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model including variables ROTEM EXTEM-MCF (Maximum Clot Firmness), which in previous data has been suggested a suitable marker of hypercoagulation, age and respiratory frequency was developed using logistic regression to evaluate the probability of death. Results: Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-CT (Coagulation Time) was observed, supporting a SARS-CoV-2 effect on prolonged initiation of coagulation. Conclusions: Here we show that hypercoagulation measured with ROTEM predicts 30-days mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.

Viscoelastic testing: Critical appraisal of new methodologies and current literature

“…Meta‐analyses of COVID‐19 VET studies confirms the common finding of increased clot strength 95 . In a study of 141 COVID‐19 patients, risk of death was significantly associated with increased EXTEM‐MCF 96 . Use of VET to predict thromboembolism in COVID‐19 has shown mixed results, however 97,98 …”

“…95 In a study of 141 COVID-19 patients, risk of death was significantly associated with increased EXTEM-MCF. 96 Use of VET to predict thromboembolism in COVID-19 has shown mixed results, however. 97,98 Lysis indices are often quite low in COVID-19 patients and their blood often shows decreased responsiveness to exogenous tPA.…”

Tocilizumab Reduces Hypercoagulation in COVID-19 – Perspectives from The Coagulation and Immunomodulation Covid Assessment (Coag- ImmCovA) Clinical Trial

“…COVID-19 is characterized by a hypercoagulable condition, with disturbances in the hemostatic balance contributing to a highly prothrombotic state 11,12 . High thrombosis incidence has been observed in both the arterial and venous circulation of COVID-19 patients, accompanied by elevated D-dimer and plasma fibrinogen levels [13][14][15][16][17] .…”