Evaluation of coagulation status using viscoelastic testing in Intensive Care patients with COVID-19: An observational point prevalence cohort study

Collett, Luke Wallace; Gluck, Samuel; Michael, Richard; Reddi, Benjamin John

BACKGROUND: Coronavirus-19 (COVID-19) is associated with a high rate of thrombosis, the pathophysiology of which is not well defined. Viscoelastic testing may identify and characterise hypercoagulable states which are not apparent using conventional coagulation assays OBJECTIVES: To undertake viscoelastic evaluation of the coagulation state in critically ill adults with COVID-19 associated respiratory failure METHODS: Single centre observational point prevalence cohort study of adults requiring respiratory support in the intensive care unit with COVID-19 associated respiratory failure. Coagulation status was evaluated using rotational thromboelastometry in conjunction with laboratory markers of coagulation. RESULTS: Six patients fulfilled inclusion criteria. Each patient had one ROTEM performed. All patients had supra-normal clot amplitude at 10 minutes (A10) and supra-normal clot firmness (MCF) measured in at least one ROTEM pathway, and 5 were supra-normal on all pathways. Minimal clot lysis was present on all analyses. Fibrinogen and d-dimer were elevated and routine markers of coagulation within normal ranges in all patients. CONCLUSION: Patients admitted to ICU with COVID-19 associated respiratory failure exhibit a hyper-coagulable state which is not appreciable on conventional tests of coagulation. Supra-normal clot firmness, minimal fibrinolysis and hyperfibrinogenaemia are key findings. Further research is required into the pathophysiology of this hypercoagulable state, as well as the harms and benefits of different anticoagulation strategies.