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Hypercoagulable viscoelastic blood clot characteristics in critically ill coronavirus disease 2019 patients and associations with thrombotic complications.
Roh, David J; Eiseman, Katherine; Kirsch, Hannah; Yoh, Nina; Boehme, Amelia; Agarwal, Sachin; Park, Soojin; Connolly, E Sander; Claassen, Jan; Wagener, Gebhard.
  • Roh DJ; From the Division of Critical Care and Hospitalist Neurology (D.J.R., H.K., A.B., S.A., S.P., J.C.), Department of Neurology, New York-Presbyterian Hospital and Vagelos College of Physicians and Surgeons, Columbia University; Department of Neurology (A.B.), Vagelos College of Physicians and Surgeons, Columbia University; Department of Neurological Surgery (N.Y., E.S.C.), New York-Presbyterian Hospital and Vagelos College of Physicians and Surgeons, Columbia University; and Department of Anesthes
J Trauma Acute Care Surg ; 90(1): e7-e12, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1117212
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Laboratory Procedures USES Coagulation procedure
Subject
Laboratory Procedures
Predicate
USES
Object
Coagulation procedure
3. Thromboelastometry ADMINISTERED_TO Patients
Subject
Thromboelastometry
Predicate
ADMINISTERED_TO
Object
Patients
4. Rotational test ADMINISTERED_TO Patients
Subject
Rotational test
Predicate
ADMINISTERED_TO
Object
Patients
5. Patients LOCATION_OF Fibrin fragment D
Subject
Patients
Predicate
LOCATION_OF
Object
Fibrin fragment D
6. COVID-19 PROCESS_OF Cohort
Subject
COVID-19
Predicate
PROCESS_OF
Object
Cohort
7. Complication PROCESS_OF Patients
Subject
Complication
Predicate
PROCESS_OF
Object
Patients
8. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
9. D-dimer above reference range PROCESS_OF Patients
Subject
D-dimer above reference range
Predicate
PROCESS_OF
Object
Patients
10. fibrinogen TREATS Complication
Subject
fibrinogen
Predicate
TREATS
Object
Complication
11. fibrinogen TREATS COVID-19
Subject
fibrinogen
Predicate
TREATS
Object
COVID-19
12. fibrinogen TREATS Patients
Subject
fibrinogen
Predicate
TREATS
Object
Patients
13. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
14. Laboratory Procedures USES Coagulation procedure
Subject
Laboratory Procedures
Predicate
USES
Object
Coagulation procedure
15. Thromboelastometry ADMINISTERED_TO Patients
Subject
Thromboelastometry
Predicate
ADMINISTERED_TO
Object
Patients
16. Rotational test ADMINISTERED_TO Patients
Subject
Rotational test
Predicate
ADMINISTERED_TO
Object
Patients
17. Patients LOCATION_OF Fibrin fragment D
Subject
Patients
Predicate
LOCATION_OF
Object
Fibrin fragment D
18. COVID-19 PROCESS_OF Cohort
Subject
COVID-19
Predicate
PROCESS_OF
Object
Cohort
19. Complication PROCESS_OF Patients
Subject
Complication
Predicate
PROCESS_OF
Object
Patients
20. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
21. D-dimer above reference range PROCESS_OF Patients
Subject
D-dimer above reference range
Predicate
PROCESS_OF
Object
Patients
22. fibrinogen TREATS Complication
Subject
fibrinogen
Predicate
TREATS
Object
Complication
23. fibrinogen TREATS COVID-19
Subject
fibrinogen
Predicate
TREATS
Object
COVID-19
24. fibrinogen TREATS Patients
Subject
fibrinogen
Predicate
TREATS
Object
Patients
ABSTRACT

BACKGROUND:

Critically ill coronavirus disease 2019 (COVID-19) patients have frequent thrombotic complications and laboratory evidence of hypercoagulability. The relationship of coagulation tests and thrombosis requires investigation to identify best diagnostic and treatment approaches. We assessed for hypercoagulable characteristics in critically ill COVID-19 patients using rotational thromboelastometry (ROTEM) and explored relationships of D-dimer and ROTEM measurements with thrombotic complications.

METHODS:

Critically ill adult COVID-19 patients receiving ROTEM testing between March and April 2020 were analyzed. Patients receiving therapeutic anticoagulation before ROTEM were excluded. Rotational thromboelastometry measurements from COVID-19 patients were compared with non-COVID-19 patients matched by age, sex, and body mass index. Intergroup differences in ROTEM measurements were assessed using t tests. Correlations of D-dimer levels to ROTEM measurements were assessed in COVID-19 patients who had available concurrent testing. Intergroup differences of D-dimer and ROTEM measurements were explored in COVID-19 patients with and without thrombosis.

RESULTS:

Of 30 COVID-19 patients receiving ROTEM, we identified hypercoagulability from elevated fibrinogen compared with non-COVID-19 patients (fibrinogen assay maximum clot firmness [MCF], 47 ± 13 mm vs. 20 ± 7 mm; mean intergroup difference, 27.4 mm; 95% confidence interval [CI], 22.1-32.7 mm; p < 0.0001). In our COVID-19 cohort, thrombotic complications were identified in 33%. In COVID-19 patients developing thrombotic complications, we identified higher D-dimer levels (17.5 ± 4.3 µg/mL vs. 8.0 ± 6.3 µg/mL; mean difference, 9.5 µg/mL; 95% CI, 13.9-5.1; p < 0.0001) but lower fibrinogen assay MCF (39.7 ± 10.8 mm vs. 50.1 ± 12.0 mm; mean difference, -11.2 mm; 95% CI, -2.1 to -20.2; p = 0.02) compared with patients without thrombosis. We identified negative correlations of D-dimer levels and ROTEM MCF in these patients (r = -0.61; p = 0.001).

CONCLUSION:

We identified elevated D-dimer levels and hypercoagulable blood clot characteristics from increased fibrinogen on ROTEM testing in critically ill COVID-19 patients. However, we identified lower, albeit still hypercoagulable, ROTEM measurements of fibrinogen in COVID-19 patients with thrombotic complications compared with those without. Further work is required to externally validate these findings and to investigate the mechanistic drivers for these relationships to identify best diagnostic and treatment approaches for these patients. LEVEL OF EVIDENCE Epidemiologic, level IV.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombelastography / Thrombosis / Fibrin Fibrinogen Degradation Products / Thrombophilia / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Topics: Variants Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Trauma Acute Care Surg Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombelastography / Thrombosis / Fibrin Fibrinogen Degradation Products / Thrombophilia / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Topics: Variants Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Trauma Acute Care Surg Year: 2021 Document Type: Article