Point of care diagnostic of hypercoagulability and platelet function in COVID-19 induced acute respiratory distress syndrome: a retrospective observational study

Abstract

Background: Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT.

Methods: This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020.

Results: Median age was 61 years (IQR: 51-69). Median PaO₂/FiO₂ on admission was 122 mmHg (IQR: 87-189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD: 3.7; 95 %CI 1.3-10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications.

Conclusions: Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications..

Keywords: Acute Respiratory Distress Syndrome; COVID-19; Impedance aggregometry; Point of care testing; Thromboelastometry.

Fig. 1

Platelet aggregation ability by Multiplate®. Correlation between ∆A10 (EXTEM minus FIBTEM) and platelet count, mean platelet volume and platelet aggregation ability (Multiplate® with TRAP-6 and ADP). a ∆A10 vs. platelet count. b ∆A10 vs. mean platelet volume. c ∆A10 vs. Multiplate® with agonist TRAP-6. d ∆A10 vs. Multiplate® with agonist ADP. Values are presented during the course of ICU stay for day 1 (●), day 4 (■), day 7 (▲) and day 14 (▼) respectively. Spearman correlation coefficient is displayed by r_s. Reference values for platelet count, mean platelet volume, TRAP-6 and ADP are indicated by pink boxes

Fig. 2

Typical examples of Rotem® INTEM, EXTEM and FIBTEM measurements for a COVID-19 ARDS patient and a healthy control. Typical examples of Rotem® INTEM, EXTEM and FIBTEM measurements for a COVID-19 ARDS patient and a healthy control. Units are displayed in square brackets and reference values in round brackets. Abnormal values are presented in red. Abbreviations: Clotting Time (CT), Clot Formation Time (CFT), Amplitude 10 min after CT (A10), Maximum Clot Firmness (MCF), Lysis Index 30 min (LI30).