Thromboembolism, Hypercoagulopathy, and Antiphospholipid Antibodies in Critically Ill Coronavirus Disease 2019 Patients: A Before and After Study of Enhanced Anticoagulation

Linden, Jan van der; Almskog, Lou M.; Liliequist, Andreas; Grip, Jonathan; Fux, Thomas; Rysz, Susanne; Ågren, Anna; Oldner, Anders; Ståhlberg, Marcus

doi:10.1097/cce.0000000000000308

Cited by 22 publications

(30 citation statements)

References 12 publications

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“…Among articles reporting data about TEG, four were prospective studies [52,[59][60][61], ten were retrospective studies [51,[53][54][55][56][57][58][62][63][64], and one was a case report [65]. Among articles dealing with ROTEM, thirteen were prospective studies [28][29][30][31][32][39][40][41][42][43][44][45][46], seven were retrospective studies [27,[33][34][35][36]48,49], one was a cross-sectional study [47], and four were case reports [26,37,38,50].…”

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

“…Testing was carried out either on admission or within the following days, but the timing of blood collection for VET was specified only for 29 studies [24,26,27,[29][30][31]33,[35][36][37][38]41,[43][44][45][46][47][48]50,53,[55][56][57][58][59][65][66][67]. In some studies, the measurements were repeated during the patientʹs stay, either because of a pre-established protocol [26,27,29,45,53,59,60,67] or because of the occurrence of a thromboembolic event [65,68].…”

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

“…Data from ROTEM gamma, delta, and sigma were reported in one study, thirteen studies [28][29][30][31][32][33][34][35][36][37][38][39][40], and ten [41][42][43][44][45][46][47][48][49][50], respectively. One case report did not specify the device [26].…”

Section: Characteristics Of the Included Patientsmentioning

confidence: 99%

“…Among the 18 articles reporting data from EXTEM, INTEM, and FIBTEM assays, 16 [26,27,29,31,33,36,38,41,42,[44][45][46][47][48][49][50] found an increase in "amplitude of the clot" in the three assays, and 2 only in EXTEM and FIBTEM assays [43], or in FIBTEM assay alone [28]. Among the four articles reporting data from EXTEM and FIBTEM only [30,34,35,37], EXTEM only [32], EXTEM and TEM-tPA only [40], and TEM-tPA only [39], an increased in the "amplitude of the clot" was also a common finding.…”

Section: Characteristics Of the Included Patientsmentioning

confidence: 99%

“…Third, it persisted over time from admission up to 10 to 14 days later [26,27,29,45]. Fourth, it was observed even in the absence of heparin neutralization and despite higher therapeutic intensity anticoagulation administration [26,47]. Of note, only six studies [28,[33][34][35]44,49] gathering 195 patients examined the potential association with thrombotic events occurring, and only two [34,44] reported that patients with thromboembolic complications exhibited low or even absent fibrinolysis.…”

Section: Characteristics Of the Included Patientsmentioning

confidence: 99%

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Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Bareille

Hardy

Douxfils

et al. 2021

JCM

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Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

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Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

Section: Characteristics Of the Included Patientsmentioning

confidence: 99%

Section: Characteristics Of the Included Patientsmentioning

confidence: 99%

Section: Characteristics Of the Included Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Bareille

Hardy

Douxfils

et al. 2021

JCM

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Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests

Pavoni¹,

Gianesello

Pazzi³

et al. 2021

J Clin Monit Comput

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Abnormal coagulation parameters are often observed in patients with coronavirus disease 2019 (COVID-19) and the severity of derangement has been associated with a poor prognosis. The COVID-19 associated coagulopathy (CAC) displays unique features that include a high risk of developing thromboembolic complications. Viscoelastic tests (VETs), such as thromboelastometry (ROTEM), thromboelastography (TEG) and Quantra Hemostasis Analyzer (Quantra), provide "dynamic" data on clot formation and dissolution; they are used in different critical care settings, both in hemorrhagic and in thrombotic conditions. In patients with severe COVID-19 infection VETs can supply to clinicians more information about the CAC, identifying the presence of hypercoagulable and hypofibrinolysis states. In the last year, many studies have proposed to explain the underlying characteristics of CAC; however, there remain many unanswered questions. We tried to address some of the important queries about CAC through VETs analysis.

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Antiphospholipid antibodies in critically ill COVID-19 patients with thromboembolism: cause of disease or epiphenomenon?

Pavoni¹,

Gianesello

Horton

2021

J Thromb Thrombolysis

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Coronavirus 2019 disease (COVID-19) is associated with coagulation dysfunction that predisposes patients to an increased risk for both arterial (ATE) and venous thromboembolism (VTE) and consequent poor prognosis; in particular, the incidence of ATE and VTE in critically ill COVID-19 patients can reach 5% and 31%, respectively. The mechanism of thrombosis in COVID-19 patients is complex and still not completely clear. Recent literature suggests a link between the presence of antiphospholipid antibodies (aPLs) and thromboembolism in COVID-19 patients. However, it remains uncertain whether aPLs are an epiphenomenon or are involved in the pathogenesis of the disease.

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Thromboembolism, Hypercoagulopathy, and Antiphospholipid Antibodies in Critically Ill Coronavirus Disease 2019 Patients: A Before and After Study of Enhanced Anticoagulation

Abstract: Supplemental Digital Content is available in the text.

Cited by 22 publications

References 12 publications

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests

Antiphospholipid antibodies in critically ill COVID-19 patients with thromboembolism: cause of disease or epiphenomenon?

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