TY - JOUR
T1 - Utility of Thromboelastography and velocity curve derivative in diagnosing COVID-19 associated coagulopathy
AU - Mohan, Ganesh
AU - Wilson, William
AU - Paonam, Bemma
AU - Vaidya, Ashwinkumar
AU - Ravindra, Prithvishree
AU - Shastry, Shamee
AU - Balakrishnan, Jayaraj Mymbilly
AU - Rao, Shwethapriya
AU - Chaudhuri, Souvik
N1 - Funding Information:
We graciously acknowledge the effort and guidance put by Dr. Jecko Thachil, MD in completing this manuscript. He had critically reviewed this article multiple times to guide us whenever we were in doubts. We went through a lot of communications and every time, he was there to offer his knowledge and wisdom at the earliest.
Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2022
Y1 - 2022
N2 - Background: COVID-19 associated coagulopathy (CAC) can either be localized or systemic hypercoagulable state with increased risk of thromboembolism. This study looked into the usefulness of Thromboelastography (TEG) and the velocity curve (V-curve) derivative from TEG in diagnosing and differentiating different stages of CAC. Materials and Methods: A prospective single cohort study of RT-PCR confirmed COVID-19 patients was carried out for 2 weeks. Severe COVID-19 patients in the adult critical care units with a TEG report were recruited for the study. Citrated kaolin TEG was performed on the day of admission before anticoagulation. TEG parameters included were R and K time, alpha angle, maximum amplitude, clotting index, lysis at 30 min. The first-degree velocity curve of TEG is plotted as V-curve which extrapolates thrombus generation potential. Parameters analyzed were the maximum rate of thrombus generation as well as thrombus generated (TG). Results: The study included 43 patients with an average age of 58.34 (±15.35). TEG as well as V-curve of all the patients were hypercoagulable compared with age-matched reference range. We had 79.06% of patients in hypercoagulable stage. The mortality rate was 32.56% and 30.23% developed thrombotic incidents. Patients who succumbed to death had prolonged PT, aPTT, MA, Ly30, with a reduced TG (p <.05). The presence of fibrinolysis was associated with thromboembolism (OR = 6.76, CI = 1.48–25.82). Repeat TEG was done randomly in 11 patients and revealed a persistent hypercoagulable stage with increasing fibrinolysis activity. Conclusion: TEG is a useful tool in diagnosing and categorizing Coagulopathy associated with COVID-19.
AB - Background: COVID-19 associated coagulopathy (CAC) can either be localized or systemic hypercoagulable state with increased risk of thromboembolism. This study looked into the usefulness of Thromboelastography (TEG) and the velocity curve (V-curve) derivative from TEG in diagnosing and differentiating different stages of CAC. Materials and Methods: A prospective single cohort study of RT-PCR confirmed COVID-19 patients was carried out for 2 weeks. Severe COVID-19 patients in the adult critical care units with a TEG report were recruited for the study. Citrated kaolin TEG was performed on the day of admission before anticoagulation. TEG parameters included were R and K time, alpha angle, maximum amplitude, clotting index, lysis at 30 min. The first-degree velocity curve of TEG is plotted as V-curve which extrapolates thrombus generation potential. Parameters analyzed were the maximum rate of thrombus generation as well as thrombus generated (TG). Results: The study included 43 patients with an average age of 58.34 (±15.35). TEG as well as V-curve of all the patients were hypercoagulable compared with age-matched reference range. We had 79.06% of patients in hypercoagulable stage. The mortality rate was 32.56% and 30.23% developed thrombotic incidents. Patients who succumbed to death had prolonged PT, aPTT, MA, Ly30, with a reduced TG (p <.05). The presence of fibrinolysis was associated with thromboembolism (OR = 6.76, CI = 1.48–25.82). Repeat TEG was done randomly in 11 patients and revealed a persistent hypercoagulable stage with increasing fibrinolysis activity. Conclusion: TEG is a useful tool in diagnosing and categorizing Coagulopathy associated with COVID-19.
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U2 - 10.1111/ijlh.13876
DO - 10.1111/ijlh.13876
M3 - Article
C2 - 35609623
AN - SCOPUS:85130460465
SN - 1751-5521
VL - 44
SP - 823
EP - 830
JO - International Journal of Laboratory Hematology
JF - International Journal of Laboratory Hematology
IS - 5
ER -