Thromboelastographic insights into hemostatic alterations in coronavirus disease 2019 (COVID-19) patients.

INTRODUCTION

The coronavirus disease 2019 (COVID-19) has been shown to be a systemic disease affecting different organs of the body including hemostatic system. We aimed to see the utility of thromboelastography (TEG), a global viscoelastic test, in assessing hemostatic profile in COVID-19 patients.

METHODS

Laboratory records and relevant clinical profiles of our hospitalized COVID-19 patients who underwent TEG testing over a 1-year period were retrospectively studied.

RESULTS

Out of 103 patients analyzed hypercoagulability was observed on TEG in 49 (48%) patients which was due to hyperfibrinogenemia with hypofibrinolysis and it persisted till 32-56 days in a subset of recovered patients. Patients with hypercoagulable profile had higher clotting index (CI), maximum amplitude (MA), α-angle and lower K values, which correlated with plasma fibrinogen levels and platelet counts. Hypocoagulable TEG profile was observed in 10 (9%) patients out of which, seven had platelet hypocoagulability and three had plasmatic hypocoagulability. Those with hypocoagulable profile had statistically significant lower platelet counts, higher values of R and K, and lower values of angle, MA, and CI. Two patients with thrombocytopenia and normocoagulable TEG tracing had co-infection with dengue virus. Lesser recovery rate was observed in patients with hypocoagulable profile compared to those with hypercoagulable and normocoagulable profiles.

CONCLUSION

The present study confirmed significant hypercoagulability on TEG in almost half of the patients with COVID-19 despite anticoagulant therapy which was not detectable by conventional coagulation tests. It is plausible that the initial presentation for most of COVID-19 patients was that of hypercoagulable profile which eventually progressed to a hypocoagulable profile in a subset of patients with poorer prognosis.