TY - JOUR
T1 - Thromboelastography Parameters do not Discriminate for Thrombotic Events in Hospitalized Patients With COVID-19
AU - for the CRUSH COVID Investigators
AU - Kartiko, Susan
AU - Koizumi, Naoru
AU - Yamane, David
AU - Sarani, Babak
AU - Siddique, Abu B.
AU - Levine, Andrea R.
AU - Jackson, Amanda M.
AU - Wieruszewski, Patrick M.
AU - Smischney, Nathan J.
AU - Khanna, Ashish K.
AU - Chow, Jonathan H.
N1 - Funding Information:
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Ashish K. Khanna, MD FCCP FCCM FASA is a consultant for Potrero Medical, Edwards Lifesciences, Philips North America, GE Healthcare, Hillr-Rom, Trevena Pharmaceuticals, and Caretaker Medical. AKK is on the executive advisory board for Medtronic and Retia Medical. AKK receives support from the Wake Forest CTSI via NIH/NCATS KL2 for a trial of continuous portable hemodynamic and saturation monitoring on hospital wards and the Wake Forest Hypertension and Cardiovascular Sciences Research Center. The Department of Anesthesiology at the Wake Forest School of Medicine has received funding support from Edwards Lifesciences, Trevena Pharmaceuticals, Retia Medical, Caretaker Medical, and Potrero Medical.
Publisher Copyright:
© The Author(s) 2022.
PY - 2023/5
Y1 - 2023/5
N2 - Background: Coronavirus disease 2019 (COVID-19) is associated with a prothrombotic state; leading to multiple sequelae. We sought to detect whether thromboelastography (TEG) parameters would be able to detect thromboembolic events in patients hospitalized with COVID-19. Methods: We performed a retrospective multicenter case–control study of the Collaborative Research to Understand the Sequelae of Harm in COVID (CRUSH COVID) registry of 8 tertiary care level hospitals in the United States (US). This registry contains adult patients with COVID-19 hospitalized between March 2020 and September 2020. Results: A total of 277 hospitalized COVID-19 patients were analyzed to determine whether conventional coagulation TEG parameters were associated with venous thromboembolic (VTE) and thrombotic events during hospitalization. A clotting index (CI) >3 was present in 45.8% of the population, consistent with a hypercoagulable state. Eighty-three percent of the patients had clot lysis at 30 min (LY30) = 0, consistent with fibrinolysis shutdown, with a median of 0.1%. We did not find TEG parameters (LY30 area under the receiver operating characteristic [ROC] curve [AUC] = 0.55, 95% CI: 0.44-0.65, P value =.32; alpha angle [α] AUC = 0.58, 95% CI: 0.47-0.69, P value =.17; K time AUC = 0.58, 95% CI: 0.46-0.69, P value =.67; maximum amplitude (MA) AUC = 0.54, 95% CI: 0.44-0.64, P value =.47; reaction time [R time] AUC = 0.53, 95% CI: 0.42-0.65, P value =.70) to be a good discriminator for VTE. We also did not find TEG parameters (LY30 AUC = 0.51, 95% CI: 0.42-0.60, P value =.84; R time AUC = 0.57, 95%CI: 0.48-0.67, P value.07; α AUC = 0.59, 95%CI: 0.51-0.68, P value =.02; K time AUC = 0.62, 95% CI: 0.53-0.70, P value =.07; MA AUC = 0.65, 95% CI: 0.57-0.74, P value <.01) to be a good discriminator for thrombotic events. Conclusions: In this retrospective multicenter cohort study, TEG in COVID-19 hospitalized patients may indicate a hypercoagulable state, however, its use in detecting VTE or thrombotic events is limited in this population.
AB - Background: Coronavirus disease 2019 (COVID-19) is associated with a prothrombotic state; leading to multiple sequelae. We sought to detect whether thromboelastography (TEG) parameters would be able to detect thromboembolic events in patients hospitalized with COVID-19. Methods: We performed a retrospective multicenter case–control study of the Collaborative Research to Understand the Sequelae of Harm in COVID (CRUSH COVID) registry of 8 tertiary care level hospitals in the United States (US). This registry contains adult patients with COVID-19 hospitalized between March 2020 and September 2020. Results: A total of 277 hospitalized COVID-19 patients were analyzed to determine whether conventional coagulation TEG parameters were associated with venous thromboembolic (VTE) and thrombotic events during hospitalization. A clotting index (CI) >3 was present in 45.8% of the population, consistent with a hypercoagulable state. Eighty-three percent of the patients had clot lysis at 30 min (LY30) = 0, consistent with fibrinolysis shutdown, with a median of 0.1%. We did not find TEG parameters (LY30 area under the receiver operating characteristic [ROC] curve [AUC] = 0.55, 95% CI: 0.44-0.65, P value =.32; alpha angle [α] AUC = 0.58, 95% CI: 0.47-0.69, P value =.17; K time AUC = 0.58, 95% CI: 0.46-0.69, P value =.67; maximum amplitude (MA) AUC = 0.54, 95% CI: 0.44-0.64, P value =.47; reaction time [R time] AUC = 0.53, 95% CI: 0.42-0.65, P value =.70) to be a good discriminator for VTE. We also did not find TEG parameters (LY30 AUC = 0.51, 95% CI: 0.42-0.60, P value =.84; R time AUC = 0.57, 95%CI: 0.48-0.67, P value.07; α AUC = 0.59, 95%CI: 0.51-0.68, P value =.02; K time AUC = 0.62, 95% CI: 0.53-0.70, P value =.07; MA AUC = 0.65, 95% CI: 0.57-0.74, P value <.01) to be a good discriminator for thrombotic events. Conclusions: In this retrospective multicenter cohort study, TEG in COVID-19 hospitalized patients may indicate a hypercoagulable state, however, its use in detecting VTE or thrombotic events is limited in this population.
KW - COVID-19
KW - TEG
KW - VTE
KW - fibrinolysis shutdown
KW - hypercoagulable state
UR - http://www.scopus.com/inward/record.url?scp=85143620522&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85143620522&partnerID=8YFLogxK
U2 - 10.1177/08850666221142265
DO - 10.1177/08850666221142265
M3 - Article
C2 - 36448250
AN - SCOPUS:85143620522
SN - 0885-0666
VL - 38
SP - 449
EP - 456
JO - Journal of Intensive Care Medicine
JF - Journal of Intensive Care Medicine
IS - 5
ER -