Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention

PLoS One. 2022 Jan 14;17(1):e0262600. doi: 10.1371/journal.pone.0262600. eCollection 2022.

Abstract

In patients with severe forms of COVID-19, thromboelastometry has been reported to display a hypercoagulant pattern. However, an algorithm to differentiate severe COVID-19 patients from nonsevere patients and healthy controls based on thromboelastometry parameters has not been developed. Forty-one patients over 18 years of age with positive qRT-PCR for SARS-CoV-2 were classified according to the severity of the disease: nonsevere (NS, n = 20) or severe (S, n = 21). A healthy control (HC, n = 9) group was also examined. Blood samples from all participants were tested by extrinsic (EXTEM), intrinsic (INTEM), non-activated (NATEM) and functional assessment of fibrinogen (FIBTEM) assays of thromboelastometry. The thrombodynamic potential index (TPI) was also calculated. Severe COVID-19 patients exhibited a thromboelastometry profile with clear hypercoagulability, which was significantly different from the NS and HC groups. Nonsevere COVID-19 cases showed a trend to thrombotic pole. The NATEM test suggested that nonsevere and severe COVID-19 patients presented endogenous coagulation activation (reduced clotting time and clot formation time). TPI data were significantly different between the NS and S groups. The maximum clot firmness profile obtained by FIBTEM showed moderate/elevated accuracy to differentiate severe patients from NS and HC. A decision tree algorithm based on the FIBTEM-MCF profile was proposed to differentiate S from HC and NS. Thromboelastometric parameters are a useful tool to differentiate the coagulation profile of nonsevere and severe COVID-19 patients for therapeutic intervention purposes.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Blood Coagulation*
  • COVID-19 / blood*
  • COVID-19 / complications
  • COVID-19 / diagnosis
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • SARS-CoV-2 / isolation & purification
  • Severity of Illness Index
  • Thrombelastography*
  • Thrombophilia / blood*
  • Thrombophilia / diagnosis
  • Thrombophilia / etiology
  • Young Adult

Grants and funding

The authors are grateful for the financial support provided by Conselho Nacional de Densenvolvimento Científico e Tecnológico (CNPq). LFF thank the financial support provided by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), under process no. 88887.506611/2020-00 and 88887.504420/2020-00 and Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG), under process no. REDE-00140-16. LSE thank the ArboControl Brazil Project funded by the Ministry of Health, under process no. TED 74/2016 & TED 42/2017 for financial support. LAN, MSG, OTN, WF and OAMF thank CNPq for the PQ fellowship program. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.