A Prospective, Descriptive Study Evaluating The Evolution Of Covid-19 Associated Coagulopathy In Mechanically Ventilated, Critically-Ill Patients Using Standard Laboratory Coagulation Studies And Thromboelastography

Neethling, Colette

A Prospective, Descriptive Study Evaluating The Evolution Of Covid-19 Associated Coagulopathy In Mechanically Ventilated, Critically-Ill Patients Using Standard Laboratory Coagulation Studies And Thromboelastography

Thesis / Dissertation

2023

Abstract

Objectives: Few studies detail the evolution of Coronavirus disease 2019 (COVID-19) associated coagulopathy in critically-ill patients. We aimed to perform serial thromboelastography (TEG) and laboratory coagulation studies on critically-ill patients with COVID-19 over a 14-day period, comparing variables in 30-day survivors with those in non-survivors. Design: Prospective. Setting: Intensive care unit (ICU) in Cape Town, South Africa. Subjects: Forty patients with severe COVID-19 pneumonia admitted to ICU for mechanical ventilation. Interventions: None. Measurements & Main Results: On admission, TEG maximum amplitude (MA) with heparinase correction was above the upper limit of the reference range in 80% of patients while 82.5% presented with absent clot lysis. The functional fibrinogen MA was also elevated above the upper limit of the reference range in 92.5% of patients. All patients had elevated D-dimer and fibrinogen levels, prolonged prothrombin times (PT), normal platelet counts and activated partial thromboplastin times (aPTT). No significant differences in laboratory coagulation studies and TEG analysis were noted between survivors and non-survivors on admission. The heparinase MA decreased significantly with time and normalised in non-survivors on day 14 (p=0.01). The functional fibrinogen MA continued to increase in non-survivors compared to survivors on day 14 however this difference was not statistically significantly (p=0.07). No patients developed disseminated intravascular coagulation (DIC) according to the International Society on Thrombosis and Haemostasis (ISTH) after 14 days, however thrombosis and bleeding were each reported in 7.5% of patients. Conclusion: Critically-ill patients with COVID-19 admitted to ICU for mechanical ventilation were in a hypercoagulable state as demonstrated by TEG analysis. This state evolved over the 14-day observation period, emphasizing the importance of regular monitoring of coagulation parameters in these patients. A small group developed thrombotic complications despite therapeutic anticoagulation, however a similar proportion suffered a bleeding event, indicating that routine therapeutic anticoagulation should be practiced with caution.

Keywords

Anaesthesia and Perioperative Medicine

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