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

Abstract

Background SARS-CoV-2 infections are suspected to trigger the coagulation system through various pathways leading to a high incidence of thromboembolic complications, hypercoagulation and impaired fibrinolytic capacity were previously identified as potentially mechanisms. A reliable diagnostic tool for detecting both is still under discussion. This retrospective study is aimed to examine the prognostic relevance of early viscoelastic testing compared to conventional laboratory tests in COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods All mechanically ventilated patients with COVID-19 related ARDS treated in our intensive care unit (ICU) between January and March 2021 were included in this study. Viscoelastic testing (VET) was performed using the ClotPro® system after admission to our ICU. Prevalence of thromboembolic events was observed by standardized screening for venous and pulmonary thromboembolism using complete compression ultrasound and thoracic computed tomography pulmonary angiography at ICU admission, respectively. We examined associations between the severity of ARDS at admission to our ICU, in-hospital mortality and the incidence of thromboembolic events comparing conventional laboratory analysis and VET. ECMO related coagulopathy was investigated in a subgroup analysis. The data were analyzed using the Mann–Whitney U test. Results Of 55 patients enrolled in this study, 22 patients required treatment with ECMO. Thromboembolic complications occurred in 51% of all patients. Overall hospital mortality was 55%. In patients with thromboembolic complications, signs of reduced fibrinolytic capacity could be detected in the TPA assay with prolonged lysis time, median 460 s (IQR 350–560) vs 359 s (IQR 287–521, p = 0.073). Patients with moderate to severe ARDS at admission to our ICU showed increased maximum clot firmness as a sign of hypercoagulation in the EX-test (70 vs 67 mm, p < 0.05), FIB-test (35 vs 24 mm, p < 0.05) and TPA-test (52 vs 36 mm, p < 0.05) as well as higher values of inflammatory markers (CRP, PCT and IL6). ECMO patients suffered more frequently from bleeding complications (32% vs 15%). Conclusion Although, the predictive value for thromboembolic complications or mortality seems limited, point-of-care viscoelastic coagulation testing might be useful in detecting hypercoagulable states and impaired fibrinolysis in critically ill COVID-19 ARDS patients and could be helpful in identifying patients with a potentially very severe course of the disease.

Comparison of Two Viscoelastic Testing Devices in a Parturient Population

“…Existing transfusion algorithms provide cutoffs for ROTEM ® parameters to guide the substitution of blood products and coagulation factor concentrates [26,27]. ClotPro ® is a relatively new device that is increasingly being used in Europe and worldwide [16,18,[28][29][30][31]. In current clinical practice, ClotPro ® viscoelastic hemostatic assays have been used, but therapeutic consequences continue to be deduced from established algorithms based on ROTEM ® or TEG parameters [11,12,32,33].…”

Thromboelastometry-Guided Individualized Fibrinolytic Treatment for COVID-19-Associated Severe Coagulopathy Complicated by Portal Vein Thrombosis: A Case Report

“…Their findings were strengthened by a study conducted by Wright and colleagues who reported that combination of high D-dimer levels and hypofibrinolysis indicated by VET showed the best predictive value for thrombotic events and renal failure [ 4 ]. In 2022, Heubner and colleagues reported that VET may predict the severity of disease, and might be useful in detecting impaired fibrinolysis in patient with COVID-19-associated ARDS [ 22 ], hence there is some rationale to utilize point-of-care VET in daily practice in order to manage CAC appropriately [ 23 ]. In 2021, Wang et al developed a practical TEG-based anticoagulation algorithm to screen and identify patients at high risk for both thrombotic and bleeding complications and to guide their management [ 24 ].…”

Monitoring the Coagulation Profile of COVID-19 Patients Using Standard and ClotPro® Hemostasis Tests

“…In ClotPro ® , viscoelastic assays can be used to assess hypercoagulability. In patients with COVID-19, various groups have noted a shorter time for clot generation (CT), elevated fibrinogen concentration and function (A10), increased maximum clot firmness (MCF), and increased clot stability [ 31 ]. Many researchers performed viscoelastic tests on patients with COVID-19 in studies that enrolled only 20–50 patients.…”