Thromboelastography findings in critically ill COVID-19 patients
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LETTER TO THE EDITOR
Thromboelastography findings in critically ill COVID-19 patients Nouran Salem1 · Bassam Atallah1,2 · Wasim S. El Nekidy1,2 · Ziad G. Sadik1 · Woosup Michael Park3 · Jihad Mallat2,4,5 Accepted: 26 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The rate of venous and arterial thrombotic events among patients infected with severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is high. This may be due to a hypercoagulable state induced by the severe inflammation that results from the SAR-CoV-2 infection. We aimed to determine hypercoagulable states’ incidence based on thromboelastography study and its association with thrombotic events in critically ill patients with coronavirus disease 2019 (COVID-19). Fifty-two COVID-19 patients who had thromboelastography study were retrospectively included. All patients received pharmacologic thromboprophylaxis. The hypercoagulable state was observed in 16 patients (30.8%). Among them, maximum amplitude and a-angle were elevated in 75% and 25%, respectively. Reaction time and K were low in only 12.5% for both of them. Inflammatory and coagulation markers, as well as thromboprophylaxis regimens, were not associated with a hypercoagulable state. Fourteen patients (27%) experienced a total of 16 thrombotic events, including 8 (57%) deep venous thrombosis, 6 (43%) pulmonary embolism, and 2 (14.3%) arterial thrombosis. The hypercoagulable state was not significantly associated with thrombotic events. In summary, we observed a lower rate of hypercoagulable state on thromboelastography study in critically ill COVID-19 patients. Also, the hypercoagulable state was not associated with the occurrence of thrombotic events. Keywords COVID-19 · Thromboembolism · Thrombotic events · Thromboelastography (TEG) · Hypercoagulable state · Critically ill patients Abbreviations ICU Intensive care unit SARS-CoV-2 Severe acuterespiratory syndrome coronavirus 2 COVID-19 Coronavirus disease TEG Thromboelastography TE Thrombotic event HS Hypercoagulable state DVT Deepvenous thrombosis PE Pulmonary embolism * Jihad Mallat [email protected] 1
Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
2
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
3
Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
4
Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates
5
Normandy University, UNICAEN, ED 497, Caen, France
VTE Venous thromboembolism LLN Lower limit of normal ULN Upper limit of normal IQR Interquartile range MA Maximum amplitude LY30 Lysis at 30 minutes
Introduction Severe acute respiratory syndrome coronavirus-2 (SARCoV-2) responsible for the coronavirus disease 2019 (COVID-19) has hit the world as a global pandemic at an unprecedented scale. High rates of venous and arterial thrombotic events (TE) were observed in
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