The Role of TEG Analysis in Patients with COVID-19-Associated Coagulopathy: A Systematic Review - PubMed (original) (raw)

Review

The Role of TEG Analysis in Patients with COVID-19-Associated Coagulopathy: A Systematic Review

Jan Hartmann et al. Diagnostics (Basel). 2021.

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.

Keywords: COVID-19; TEG; blood coagulation; coronavirus; fibrinolysis; thromboelastography; viscoelastic.

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Conflict of interest statement

J.H., A.E., D.M. and J.D.D. were employees of Haemonetics at the time of the study. The roles of each author in the study design, data collection, analysis and interpretation, and the writing of the manuscript are given in the Author Contributions section above.

Figures

Figure 1

Figure 1

PRISMA diagram showing articles identified for inclusion in the review. COVID-19, coronavirus disease 2019; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TEG, thromboelastography.

Figure 2

Figure 2

TEG MA values observed in patients with COVID-19. Grey bars show the normal TEG reference range [10]. CK, citrated kaolin assay; CFF, citrated functional fibrinogen assay; CKH, CK with heparinase assay; MA, maximum amplitude. * TEG measurements recorded before and after endovascular stent graft exclusion of the aortic thrombus and right lower limb embolectomy following diagnosis of acute ischemic limb. † Twice weekly TEG measurements recorded two weeks after the introduction of high-dose pharmacological thrombosis prophylaxis. ‡ Measurements were repeated on two consecutive days in six patients. Data points are mean with standard deviation error bars for normally distributed data, or median with interquartile range error bars for data that were not normally distributed. Dotted lines separate different studies with different patient populations. Data are not directly comparable between studies.

Figure 3

Figure 3

TEG LY30 values observed in patients with COVID-19. Grey bar shows the normal TEG reference range [10]. CK, citrated kaolin assay; CKH, CK with heparinase assay; LY30, clot lysis at 30 min after maximum clot strength. * TEG measurements recorded before and after endovascular stent graft exclusion of the aortic thrombus and right lower limb embolectomy following diagnosis of acute ischemic limb. † Measurements were repeated on two consecutive days in six patients. ‡ LY30 range reported: 0–54.3%. Data points are mean with standard deviation error bars for normally distributed data, or median with interquartile range error bars for data that were not normally distributed. Dotted lines separate different studies with different patient populations. Data are not directly comparable between studies.

Figure 4

Figure 4

TEG R-time values observed in patients with COVID-19. Grey bars show the normal TEG reference range [10]. CK, citrated kaolin assay; CKH, CK with heparinase assay; R-time, reaction time. * TEG measurements recorded before and after endovascular stent graft exclusion of the aortic thrombus and right lower limb embolectomy following diagnosis of acute ischemic limb. † Measurements were repeated on two consecutive days in six patients. Data points are mean with standard deviation error bars for normally distributed data, or median with interquartile range error bars for data that were not normally distributed. Dotted lines separate different studies with different patient populations. Data are not directly comparable between studies.

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