Abstract
Background: Viscoelastic coagulation testing has been suggested to help manage coagulopathy in critically ill patients with COVID-19. However, results from different viscoelastic devices are not readily comparable. ClotPro® is a novel thromboelastometry analyzer offering a wider range of commercially available assays.Methods: We compared the results from ClotPro with results from the well-established ROTEM® Delta device and conventional coagulation tests in critically ill patients with COVID-19.Results: Viscoelastic parameters indicated the presence of a potentially hypercoagulable state in the majority of patients. In up to 95 paired measurements, we found strong correlations between several parameters routinely used in clinical practice: (i) EX test vs. EXTEM CT, A5, A10, MCF, (ii) IN test vs. INTEM A5, A10, MCF, and (iii) FIB test vs. FIBTEM A5, A10, MCF (all R > 0.7 and p < 0.001). In contrast, IN test CT vs. INTEM CT showed only a moderate correlation (R = 0.53 and p < 0.001). Clot strength parameters of both devices exhibited strong correlations with platelet counts and fibrinogen levels (all R > 0.7 and p < 0.001). Divergent correlations of intrinsically activated assays with aPTT and anti-factor Xa activity were visible. Regarding absolute differences of test results, considerable delta occurred in CT, CFT, and clot strength parameters (all p < 0.001) between both devices.Conclusions: Several parameters obtained by ClotPro show strong correlations with ROTEM Delta. Due to weak correlations of intrinsically activated clotting times and considerable absolute differences in a number of parameters, our findings underline the need for device-specific algorithms in this patient cohort.
Highlights
Ill patients with COVID-19 might exhibit a number of complex coagulation abnormalities that have been consistently associated with a hypercoagulable state [1]
We conducted a review of data from all critically ill patients with COVID-19 disease (SARS-CoV2 detected by polymerase chain reaction) admitted to a single tertiary center, the Medical University of Vienna, between 1 April 2020 and 15 December 2020
Between 1 April 2020 and 15 December 2020, 86 critically ill patients with COVID-19 were admitted to an intensive care unit (ICU) of the Medical University of Vienna
Summary
Ill patients with COVID-19 might exhibit a number of complex coagulation abnormalities that have been consistently associated with a hypercoagulable state [1]. Characteristic findings include the occurrence of endothelial injury [2], increase in factor VIII, von Willebrand factor, and fibrinogen [3], the release of cytokines [4], increased plasma viscosity [5], complement activation [6], and impaired fibrinolysis [7]. Conventional coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and antithrombin activity cannot sufficiently depict these changes [8, 9]. ClotPro® is a novel thromboelastometry analyzer offering a wider range of commercially available assays
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