1122 Thromboelastography unchanged in pregnant women with COVID-19 compared to uninfected controls: a cohort study

Abstract

COVID-19 is associated with thrombocytopenia and both coagulopathy and thrombosis in pregnant and non-pregnant individuals. Thromboelastography (TEG) is an established test that allows a more global assessment of the clotting system and is helpful in determining blood component replacement during hemorrhage. Our objective was to compare the risk of coagulopathy and thrombosis in pregnant patients admitted with SARS-CoV-2 compared to uninfected controls using TEG. Our primary outcome was to assess factor coagulation and clot strength as measured by Reaction time (R) and Maximal Amplitude (MA) on TEG, respectively. In this observational cohort study, approved by our institutional IRB, a TEG (Figure 1) and other coagulation tests were performed in pregnant patients who were SARS-CoV-2 positive by nasopharyngeal swab PCR or under investigation for COVID-19 on admission to Labor and Delivery between May 5th and June 29th 2020. QQ plots and Shapiro-Wilk test were utilized to assess the normality. Statistical tests for primary and secondary outcome were compared using independent samples t-test and Mann-Whitney U test, as appropriate. Twenty patients were included; 10 were SARS-CoV-2 positive and the remaining 10 were negative. There were no differences in baseline demographics between groups. None were admitted to ICU and all recovered well with favorable obstetric outcomes. There were no differences in TEG parameters (including R, Angle, MA) or in routine coagulation labs (platelet count, PT, PTT, and Fibrinogen) between those with or without COVID-19 (Table 1). Both TEG and other coagulation parameters were similar between pregnant women with or without COVID-19 infection, suggesting normal pregnancy coagulation in patients with low-to-moderate severity of disease. Modification of anticoagulation guidelines may not be warranted in the absence of severe COVID-19 disease.