COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical Illness
Hypercoagulability and thrombosis remain a challenge to diagnose and treat in severe COVID-19 infection. The ability of conventional global coagulation tests to accurately reflect in vivo hypo- or hypercoagulability is questioned. The currently available evidence suggests that markedly increased D-d...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/10/10/817 |
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| author | Argirios E. Tsantes Andreas G. Tsantes Styliani I. Kokoris Stefanos Bonovas Frantzeska Frantzeskaki Iraklis Tsangaris Petros Kopterides |
| author_facet | Argirios E. Tsantes Andreas G. Tsantes Styliani I. Kokoris Stefanos Bonovas Frantzeska Frantzeskaki Iraklis Tsangaris Petros Kopterides |
| author_sort | Argirios E. Tsantes |
| collection | DOAJ |
| description | Hypercoagulability and thrombosis remain a challenge to diagnose and treat in severe COVID-19 infection. The ability of conventional global coagulation tests to accurately reflect in vivo hypo- or hypercoagulability is questioned. The currently available evidence suggests that markedly increased D-dimers can be used in identifying COVID-19 patients who may need intensive care unit (ICU) admission and close monitoring or not. Viscoelastic methods (VMs), like thromboelastography (TEG) and rotational thromboelastometry (ROTEM), estimate the dynamics of blood coagulation. The evaluation of coagulopathy by VMs in severe COVID-19 infection seems an increasingly attractive option. Available evidence supports that COVID-19 patients with acute respiratory failure suffer from severe hypercoagulability rather than consumptive coagulopathy often associated with fibrinolysis shutdown. However, the variability in definitions of both the procoagulant profile and the clinical outcome assessment, in parallel with the small sample sizes in most of these studies, do not allow the establishment of a clear association between the hypercoagulable state and thrombotic events. VMs can effectively provide insight into the pathophysiology of coagulopathy, detecting the presence of hypercoagulability in critically ill COVID-19 patients. However, it remains unknown whether the degree of coagulopathy can be used in order to predict the outcome, establish a diagnosis or guide anticoagulant therapy. |
| first_indexed | 2024-03-10T15:39:18Z |
| format | Article |
| id | doaj.art-3a9f6460a3cc4fc0a7eec689221563cc |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T15:39:18Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-3a9f6460a3cc4fc0a7eec689221563cc2023-11-20T16:59:32ZengMDPI AGDiagnostics2075-44182020-10-01101081710.3390/diagnostics10100817COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical IllnessArgirios E. Tsantes0Andreas G. Tsantes1Styliani I. Kokoris2Stefanos Bonovas3Frantzeska Frantzeskaki4Iraklis Tsangaris5Petros Kopterides6Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, GreeceLaboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, GreeceLaboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, GreeceDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, ItalySecond Department of Critical Care, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Critical Care, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, GreeceIntensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, PA 15601, USAHypercoagulability and thrombosis remain a challenge to diagnose and treat in severe COVID-19 infection. The ability of conventional global coagulation tests to accurately reflect in vivo hypo- or hypercoagulability is questioned. The currently available evidence suggests that markedly increased D-dimers can be used in identifying COVID-19 patients who may need intensive care unit (ICU) admission and close monitoring or not. Viscoelastic methods (VMs), like thromboelastography (TEG) and rotational thromboelastometry (ROTEM), estimate the dynamics of blood coagulation. The evaluation of coagulopathy by VMs in severe COVID-19 infection seems an increasingly attractive option. Available evidence supports that COVID-19 patients with acute respiratory failure suffer from severe hypercoagulability rather than consumptive coagulopathy often associated with fibrinolysis shutdown. However, the variability in definitions of both the procoagulant profile and the clinical outcome assessment, in parallel with the small sample sizes in most of these studies, do not allow the establishment of a clear association between the hypercoagulable state and thrombotic events. VMs can effectively provide insight into the pathophysiology of coagulopathy, detecting the presence of hypercoagulability in critically ill COVID-19 patients. However, it remains unknown whether the degree of coagulopathy can be used in order to predict the outcome, establish a diagnosis or guide anticoagulant therapy.https://www.mdpi.com/2075-4418/10/10/817blood coagulation disorderCOVID-19viscoelastic methodsthrombosis |
| spellingShingle | Argirios E. Tsantes Andreas G. Tsantes Styliani I. Kokoris Stefanos Bonovas Frantzeska Frantzeskaki Iraklis Tsangaris Petros Kopterides COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical Illness Diagnostics blood coagulation disorder COVID-19 viscoelastic methods thrombosis |
| title | COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical Illness |
| title_full | COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical Illness |
| title_fullStr | COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical Illness |
| title_full_unstemmed | COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical Illness |
| title_short | COVID-19 Infection-Related Coagulopathy and Viscoelastic Methods: A Paradigm for Their Clinical Utility in Critical Illness |
| title_sort | covid 19 infection related coagulopathy and viscoelastic methods a paradigm for their clinical utility in critical illness |
| topic | blood coagulation disorder COVID-19 viscoelastic methods thrombosis |
| url | https://www.mdpi.com/2075-4418/10/10/817 |
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