Author: Almskog, L.; Wikman, A.; Svensson, J.; Wanecek, M.; Bottai, M.; van der Linden, J.; Agren, A.
Title: Rotational Thromboelastometry predicts care level in Covid-19 Cord-id: ymzlhsai Document date: 2020_6_12
ID: ymzlhsai
Snippet: Background High rates of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolisation of vital organs may be direct causes of death in COVID-19 positive individuals. If patients at high risk of developing thrombosis may be identified early, more effective prophylactic treatment could be applied. Objectives To test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in hospitalized COVID-19 patients, and whether pati
Document: Background High rates of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolisation of vital organs may be direct causes of death in COVID-19 positive individuals. If patients at high risk of developing thrombosis may be identified early, more effective prophylactic treatment could be applied. Objectives To test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in hospitalized COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. Methods COVID-19 positive patients over 18 years admitted to St Gorans Hospital, Stockholm, Sweden were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken as soon after admission to hospital as possible (median day 1 after hospitalization). The data were compared with healthy controls. Results The ROTEM variables Maximum Clot Firmness (EXTEM-MCF and FIBTEM-MCF) were significantly higher in both groups of COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was significantly longer and Clot Formation Time (EXTEM-CFT) significantly shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia. Conclusion ROTEM variables (EXTEM-MCF, FIBTEM-MCF, EXTEM-CT, EXTEM-CFT) were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis could be a potentially useful predictor of thromboembolic complications and mortality in these patients.
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