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. 2022 Oct;44(5):823-830.
doi: 10.1111/ijlh.13876. Epub 2022 May 24.

Utility of Thromboelastography and velocity curve derivative in diagnosing COVID-19 associated coagulopathy

Ganesh Mohan  1 , William Wilson  2 , Bemma Paonam  3 , Ashwinkumar Vaidya  3 , Prithvishree Ravindra  2 , Shamee Shastry  3 , Jayaraj Mymbilly Balakrishnan  2 , Shwethapriya Rao  4 , Souvik Chaudhuri  4
Affiliations

Utility of Thromboelastography and velocity curve derivative in diagnosing COVID-19 associated coagulopathy

Ganesh Mohan et al. Int J Lab Hematol. 2022 Oct.

Abstract

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.

Keywords: COVID-19; Thromboelastography; coagulopathy; fibrinolysis; mortality; thromboembolism; viscoelastic tests.

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Conflict of interest statement

We declare that we do not have any conflicts of interests among ourselves.

Figures

FIGURE 1
FIGURE 1
COVID‐19 associated coagulopathy diagnosed in Thromboelastography. Out of 43 patients, 6 had a normal TEG tracing at admission, 34 had a hypercoagulable picture, and 3 had a hypocoagulable picture. Secondary fibrinolysis was noted in 13/34 (38.23%) with a hypercoagulable picture. Primary fibrinolysis was noted in four patients. Physiological lysis activity was seen in six patients. Three patients who had Stage 3 coagulation status died within 3 days of hospital admission
FIGURE 2
FIGURE 2
Repeat Thromboelastography of 11 patients
See this image and copyright information in PMC

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