Thromboelastographic method for early decision on anticoagulant therapy in moderate to severe COVID-19 patients

  • Komang Ayu Ferdiana Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-7163-8958
  • Andi Ade Wijaya Ramlan Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Ratna Farida Soenarto Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Anas Alatas Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: blood coagulation disorder, COVID-19, intensive care unit, mortality, thromboelastography
Abstract viewed: 592 times
PDF downloaded: 505 times
HTML downloaded: 102 times
EPUB downloaded: 181 times

Abstract

BACKGROUND Coagulopathy is a serious COVID-19 complication that requires rapid diagnosis and anticoagulation. This study aimed to determine the role of coagulation examination using thromboelastography (TEG) on the decision-making time of anticoagulant therapy in COVID-19 patients and its clinical outcomes.

METHODS A prospective observational study was conducted in Cipto Mangunkusumo Hospital, Indonesia, from October 2020 to March 2021. We consecutively recruited moderate and severe COVID-19 patients in the high and intensive care units. Turnaround time, time to anticoagulant therapy decision, and clinical outcomes (length of stay and 30-day mortality) were compared between those who had a TEG examination in addition to the standard coagulation profile examination (thrombocyte count, PT, APTT, D-dimer, and fibrinogen) and those who had only a standard coagulation profile laboratory examination.

RESULTS Among 100 moderate to severe COVID-19 patients recruited, 50 patients had a TEG examination. The turnaround time of TEG was 45 (15–102) min versus 82 (19–164) min in the standard examination (p<0.001). The time to decision was significantly faster in the TEG group than the standard group (75 [42–133] min versus 184 [92–353] min, p<0.001). The turnaround time was positively correlated with time to decision (r = 0.760, p<0.001). However, TEG did not improve clinical outcomes such as length of stay (10.5 [3–20] versus 9 [2–39] days) and 30-day mortality (66% versus 64%).

CONCLUSIONS The TEG method significantly enables quicker decision-making time for moderate to severe coagulation disorder in COVID-19 patients.

References

  1. Gonzalez-Gonzalez FJ, Ziccardi MR, McCauley MD. Virchow's triad and the role of thrombosis in COVID-related stroke. Front Physiol. 2021;12:769254. https://doi.org/10.3389/fphys.2021.769254

  2. Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, et al. Hypercoagulability of COVID-19 patients in intensive care unit: a report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020;18(7):1738-42. https://doi.org/10.1111/jth.14850

  3. Ranucci M, Ballotta A, Di Dedda U, Baryshnikova E, Dei Poli M, Resta M, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020;18(7):1747-51. https://doi.org/10.1111/jth.14854

  4. Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA. 2020;324(8):799-801. https://doi.org/10.1001/jama.2020.13372

  5. Wright FL, Vogler TO, Moore EE, Moore HB, Wohlauer MV, Urban S, et al. Fibrinolysis shutdown correlation with thromboembolic events in severe COVID-19 infection. J Am Coll Surg. 2020;231(2):193-203.e1. https://doi.org/10.1016/j.jamcollsurg.2020.05.007

  6. Borczuk AC, Salvatore SP, Seshan SV, Patel SS, Bussel JB, Mostyka M, et al. COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. Mod Pathol. 2020;33(11):2156-68. https://doi.org/10.1038/s41379-020-00661-1

  7. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med. 2020;383(2):120-8. https://doi.org/10.1056/NEJMoa2015432

  8. Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med. 2020;173(4):268-77. https://doi.org/10.7326/M20-2003

  9. Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology. 2020;77(2):198-209. https://doi.org/10.1111/his.14134

  10. Darmaputri S. [The correlation of coagulation profile and 30-days mortality in COVID-19: a study towards trombocyte, PT/APTT, fibrinogen, and d-Dimer level] [master's thesis]. [Jakarta]: Universitas Indonesia; 2020.

  11. Rentsch CT, Beckman JA, Tomlinson L, Gellad WF, Alcorn C, Kidwai-Khan F, et al. Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study. BMJ. 2021;372:n311. https://doi.org/10.1136/bmj.n311

  12. Tan SS, Yan B, Saw S, Lee CK, Chong AT, Jureen R, et al. Practical laboratory considerations amidst the COVID-19 outbreak: early experience from Singapore. J Clin Pathol. 2021;74(4):257-60. https://doi.org/10.1136/jclinpath-2020-206563

  13. Shaydakov ME, Sigmon DF, Blebea J. Thromboelastography [Internet]. Treasure Island: StatPearls Publishing; 2022 Jan- [updated 2021 Apr 20; cited 2022 May 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537061/.

  14. Hartmann J, Ergang A, Mason D, Dias JD. The role of TEG analysis in patients with COVID-19-associated coagulopathy: a systematic review. Diagnostics (Basel). 2021;11(2):172. https://doi.org/10.3390/diagnostics11020172

  15. The Indonesian Society of Respirology (PDPI); Indonesian Heart Association (PERKI); Indonesian Society of Internal Medicine (PAPDI); The Indonesian Society of Anesthesiology and Intensive Therapy (PERDATIN); Indonesian Pediatric Society (IDAI). [The guideline for COVID-19 management]. 2nd ed. Jakarta: The Indonesian Society of Respirology (PDPI); Indonesian Heart Association (PERKI); Indonesian Society of Internal Medicine (PAPDI); The Indonesian Society of Anesthesiology and Intensive Therapy (PERDATIN); Indonesian Pediatric Society (IDAI); 2020. Indonesian.

  16. Galvez K, Cortes C. Thromboelastography: new concepts in haemostasis physiology and correlation with trauma associated coagulopathy. Colomb J Anesthesiol. 2012;40(3):224-30. https://doi.org/10.1097/01819236-201240030-00011

  17. Lemos ACB, do Espírito Santo DA, Salvetti MC, Gilio RN, Agra LB, Pazin-Filho A, et al. Therapeutic versus prophylactic anticoagulation for severe COVID-19: a randomized phase II clinical trial (HESACOVID). Thromb Res. 2020;196:359-66. https://doi.org/10.1016/j.thromres.2020.09.026

Published
2022-07-14
How to Cite
1.
Ferdiana KA, Ramlan AAW, Soenarto RF, Alatas A. Thromboelastographic method for early decision on anticoagulant therapy in moderate to severe COVID-19 patients. Med J Indones [Internet]. 2022Jul.14 [cited 2022Dec.10];31(2):96-101. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/5890
Section
Clinical Research