Thromboelastometry profile in critically ill patients: A single-center, retrospective, observational study

Crochemore, Tomaz; Corrêa, Thiago Domingos; Lancé, Marcus D.; Solomon, Cristina; Neto, Ary Serpa; Guerra, João Carlos de Campos; Lellis, Priscila Scolmeister; Bernz, Livia Muller; Nunes, Natália Abou Hala; Mancio, Cassio Massashi; Yokoyama, Ana Paula Hitomi; Silva, Eliézer

doi:10.1371/journal.pone.0192965

Cited by 17 publications

(21 citation statements)

References 35 publications

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“…In patients with COVID-19, there is early limited evidence of a procoagulant pattern on ROTEM® 9 , 10 and TEG 11 , 12 that appears to be persistent beyond admission. This procoagulant pattern is not commonly found in other groups of critically ill patients [13] , [14] , [15] .…”

Section: Discussionmentioning

confidence: 60%

Evaluation of coagulation status using viscoelastic testing in intensive care patients with coronavirus disease 2019 (COVID-19): An observational point prevalence cohort study

Collett

Gluck

Strickland

et al. 2021

Australian Critical Care

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Background Coronavirus Disease-19 (COVID-19) is associated with a high rate of thrombosis, the pathophysiology of which is not well defined. Viscoelastic testing may identify and characterise hypercoagulable states which are not apparent using conventional coagulation assays. Objectives The objective of this study was to undertake viscoelastic evaluation of the coagulation state in critically ill adults with COVID-19–associated respiratory failure Methods This was a single-centre observational point prevalence cohort study of adults with COVID-19–associated respiratory failure requiring respiratory support in the intensive care unit. Coagulation status was evaluated using rotational thromboelastometry (ROTEM®) in conjunction with laboratory markers of coagulation. Results Six patients fulfilled inclusion criteria. Each patient had one ROTEM® performed. All patients had supranormal clot amplitude at 10 min (A10) and supranormal clot firmness (maximal clot firmness) measured in at least one ROTEM® pathway, and five were supranormal on all pathways. Minimal clot lysis was present on all analyses. Fibrinogen and D-dimer were elevated and routine markers of coagulation within normal ranges in all patients. Conclusion Patients with COVID-19–associated respiratory failure admitted to the intensive care unit exhibit a hypercoagulable state which is not appreciable on conventional tests of coagulation. Supranormal clot firmness, minimal fibrinolysis, and hyperfibrinogenaemia are key findings. Further research is required into the pathophysiology of this hypercoagulable state, as well as the harms and benefits of different anticoagulation strategies.

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Section: Discussionmentioning

confidence: 60%

Evaluation of coagulation status using viscoelastic testing in intensive care patients with coronavirus disease 2019 (COVID-19): An observational point prevalence cohort study

Collett

Gluck

Strickland

et al. 2021

Australian Critical Care

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“…Prior studies have evaluated thromboelastography profiles in critically ill medical and surgical patients, predominantly focused on elevated MA as a marker of hypercoagulability, and have demonstrated conflicting results (23)(24)(25). In a study of 50 patients with sepsis, 30% had a hypercoagulable thromboelastography defined by elevated MA at admission to the ICU, while 22% were hypocoagulable with MA below the lower limit of normal (23).…”

Section: Discussionmentioning

confidence: 99%

Thromboelastography Profiles of Critically Ill Patients With Coronavirus Disease 2019

Yuriditsky¹,

Horowitz²,

Merchan

et al. 2020

Critical Care Medicine

109

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Objectives: The rate of thromboembolic events among patients with coronavirus disease 2019 is high; however, there is no robust method to identify those at greatest risk. We reviewed thromboelastography studies in critically ill patients with coronavirus disease 2019 to characterize their coagulation states. Design: Retrospective. Setting: Tertiary ICU in New York City. Patients: Sixty-four patients with coronavirus disease 2019 admitted to the ICU with thromboelastography performed. Interventions: None. Measurements and Main Results: Fifty percent of patients had a clotting index in the hypercoagulable range (clotting index > 3) (median 3.05). Reaction time and K values were below the lower limit of normal in 43.8% of the population consistent with a hypercoagulable profile. The median α angle and maximum amplitude (75.8° and 72.8 mm, respectively) were in the hypercoagulable range. The α angle was above reference range in 70.3% of patients indicative of rapid clot formation. Maximum amplitude, a factor of fibrinogen and platelet count and function, and a measure of clot strength was above reference range in 60.1% of patients. Thirtyone percent had thromboembolic events; thromboelastography parameters did not correlate with events in our cohort. Those with d-dimer values greater than 2,000 were more likely to have shorter reaction times compared with those with d-dimer levels less than or equal to 2,000 (4.8 vs 5.6 min; p = 0.001). Conclusions: A large proportion of critically ill patients with coronavirus disease 2019 have hypercoagulable thromboelastography profiles with additional derangements related to fibrinogen and platelet function. As the majority of patients have an elevated thromboelastography maximum amplitude, a follow-up study evaluating platelet aggregation would be instructive.

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“…The analyses were performed by pipetting 340 μl of citrated whole blood and 20 μl of 0.2 M calcium chloride with specific activators into a cup. There was no change in methodology for test performance nor test controls (Rotrol N and Rotrol P) throughout the study period [15,20].…”

Section: Laboratory Analysismentioning

confidence: 99%

Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study

et al. 2020

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Background Coagulation abnormalities in COVID-19 patients have not been addressed in depth. Objective To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19. Methods Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10. Results Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM–FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability. Conclusion COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.

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Thromboelastometry profile in critically ill patients: A single-center, retrospective, observational study

Cited by 17 publications

References 35 publications

Evaluation of coagulation status using viscoelastic testing in intensive care patients with coronavirus disease 2019 (COVID-19): An observational point prevalence cohort study

Evaluation of coagulation status using viscoelastic testing in intensive care patients with coronavirus disease 2019 (COVID-19): An observational point prevalence cohort study

Thromboelastography Profiles of Critically Ill Patients With Coronavirus Disease 2019

Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study

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