Examining the role of thromboelastography in patients with COVID-19

Abstract

Background

COVID-19 causes a severe respiratory distress syndrome. Systemic inflammation and hypercoagulability are common. These findings are often evaluated with non-specific markers, including CRP, D-dimer, and fibrinogen. We sought to evaluate thromboelastography (TEG) to better understand this complex coagulopathy.

Methods

We conducted a prospective observational study analyzing TEG results in hospitalized patients with COVID-19. TEG was performed on admission and at pre-set intervals. Based on the TEG findings, patients were deemed “hypercoagulable” or “not hypercoagulable.” Clinical outcomes were recorded.

Results

88 patients were evaluated. 78/88 (89%) were hypercoagulable. 10% of the hypercoagulable group (8/78) died compared to none in the non-hypercoagulable group (0/10), with thrombotic events occurring in 9% (8/88), a higher requirement for O2 support in 19% (17/88), and prolonged length of stay exceeding 4 days for 74% (65/88). No statistical significant differences were observed between the groups for any of the four adverse events. Patients with complete fibrinolysis shutdown (Ly30 = 0) had more thrombotic events than those with Ly30 > 0 (30% vs 0%, p = .03).

Conclusion

Patients with COVID-19 are often hypercoagulable based upon specific TEG parameters. While many TEG parameters are not associated with adverse outcomes, complete fibrinolysis shutdown is associated with an increased risk of thrombotic events. Further studies are warranted to assess the utility of TEG in this population.