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 - 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
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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 -