Abstract
Coronavirus disease 2019 (COVID-19)-associated coagulopathy (CAC), characterized by hypercoagulability and an increased risk of thrombotic complications, is an important consideration in the management of patients with COVID-19. As COVID-19 is a new disease, no standard of care for the diagnosis or management of its associated coagulopathy is yet established. Whole blood viscoelastic tests, such as thromboelastography (TEG® hemostasis analyzer), analyze whole blood to provide a complete overview of the coagulation status. We conducted a systematic review of thromboelastography for management of patients with COVID-19, using MEDLINE (PubMed) and Cochrane databases. TEG® parameter measurements and clinical outcomes data were extracted for analysis. Our review found 15 publications, with overall results showing thromboelastography can identify and assess a hypercoagulable state in patients with COVID-19. Furthermore, utilization of thromboelastography in this patient population was shown to predict thrombotic complications. The benefits of thromboelastography presented here, in addition to advantages compared with laboratory coagulation tests, position thromboelastography as an important opportunity for optimizing diagnosis of CAC and improving patient management in COVID-19. Given that the benefits of thromboelastography have already been demonstrated in several other clinical applications, we anticipate that clinical data from future studies in patients with COVID-19 will further elucidate the optimal use of thromboelastography in this patient population.
Highlights
First described in patients in China, the severe, acute respiratory syndrome coronavirus disease 2019 (COVID-19) has rapidly reached Europe and the US and led to a global pandemic of unprecedented proportion and disruption [1]
The unique hypercoagulopathy state seen in patients with COVID-19 has been explored using both thrombin generation assays and viscoelastic hemostatic analyzers (VHA) [4]
In order to gain a clearer picture of the use of thromboelastography in COVID-19, we performed a systematic literature review of the MEDLINE (PubMed) and Cochrane databases to identify relevant literature assessing the role of thromboelastography in the management and treatment of patients with COVID-19
Summary
First described in patients in China, the severe, acute respiratory syndrome coronavirus disease 2019 (COVID-19) has rapidly reached Europe and the US and led to a global pandemic of unprecedented proportion and disruption [1]. COVID-19 was initially described as a lung-focused SARS-like respiratory disease, with lead symptoms of cough, shortness of breath, and fever. Reports have demonstrated that COVID-19 infection can lead to an array of organ-specific and systemic phenotypes, with patients who share etiologies presenting very differently and requiring different pathways of care [2]. One important complication of the disease that can impact patient care and management is COVID-19-associated coagulopathy (CAC), characterized by hypercoagulability and a prothrombotic state with increased risk of thrombotic events (TEs), including deep vein thrombosis, pulmonary embolism, ischemic stroke, and myocardial infarction [3].
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