The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illness
In critically ill patients with COVID-19, concomitant abnormalities of coagulation have been seen with an unusually high incidence, often despite seemingly appropriate prophylactic anti-coagulation. It appears that standard coagulation tests are limited in their ability to accurately reflect the sev...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Termedia Publishing House
2021-09-01
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| Series: | Anaesthesiology Intensive Therapy |
| Subjects: | |
| Online Access: | https://www.termedia.pl/The-role-of-rotational-thromboelastometry-in-understanding-the-coagulation-problems-in-COVID-19-associated-critical-illness,118,45270,1,1.html |
| _version_ | 1797999796946993152 |
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| author | Natalie Duric Tamas Szakmany |
| author_facet | Natalie Duric Tamas Szakmany |
| author_sort | Natalie Duric |
| collection | DOAJ |
| description | In critically ill patients with COVID-19, concomitant abnormalities of coagulation have been seen with an unusually high incidence, often despite seemingly appropriate prophylactic anti-coagulation. It appears that standard coagulation tests are limited in their ability to accurately reflect the severity of the prothrombotic phenotype observed in severe COVID-19 infections. In this narrative review we consider the role of a global haemostatic assay, rotational thromboelastometry (ROTEM), as a near bedside test allowing a more comprehensive assessment of haemostatic function in the context of COVID-19 infection.
A comprehensive literature search was conducted on PubMed using the keywords “COVID-19” OR “SARS-CoV-2” AND “Rotational thromboelastometry”. Sixteen original articles were included for analysis and two existing literature reviews were considered. Whilst not the perfect substitute for in vivo coagulation, studies utilising rotational thromboelastometry assays in COVID-19 patients have demonstrated increased maximum clot firmness (consistent with hypercoagulability) and reduced maximum lysis (consistent with “fibrinolytic shutdown”). There is a possible association with disease severity and degree of hypercoagulability and hypofibrinolysis as a possible tool for risk stratification and the potential modulation of fibrinogen-dependent maximum clot firmness with enhanced anticoagulation strategies.
Precisely how these coagulation abnormalities can be modified by optimum, individualised medical interventions to improve clinical outcomes, however, remains unclear. |
| first_indexed | 2024-04-11T11:10:26Z |
| format | Article |
| id | doaj.art-3e44b342d98249828ffed185db358a77 |
| institution | Directory Open Access Journal |
| issn | 1642-5758 1731-2531 |
| language | English |
| last_indexed | 2024-04-11T11:10:26Z |
| publishDate | 2021-09-01 |
| publisher | Termedia Publishing House |
| record_format | Article |
| series | Anaesthesiology Intensive Therapy |
| spelling | doaj.art-3e44b342d98249828ffed185db358a772022-12-22T04:27:33ZengTermedia Publishing HouseAnaesthesiology Intensive Therapy1642-57581731-25312021-09-0153433634210.5114/ait.2021.10940145270The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illnessNatalie DuricTamas SzakmanyIn critically ill patients with COVID-19, concomitant abnormalities of coagulation have been seen with an unusually high incidence, often despite seemingly appropriate prophylactic anti-coagulation. It appears that standard coagulation tests are limited in their ability to accurately reflect the severity of the prothrombotic phenotype observed in severe COVID-19 infections. In this narrative review we consider the role of a global haemostatic assay, rotational thromboelastometry (ROTEM), as a near bedside test allowing a more comprehensive assessment of haemostatic function in the context of COVID-19 infection. A comprehensive literature search was conducted on PubMed using the keywords “COVID-19” OR “SARS-CoV-2” AND “Rotational thromboelastometry”. Sixteen original articles were included for analysis and two existing literature reviews were considered. Whilst not the perfect substitute for in vivo coagulation, studies utilising rotational thromboelastometry assays in COVID-19 patients have demonstrated increased maximum clot firmness (consistent with hypercoagulability) and reduced maximum lysis (consistent with “fibrinolytic shutdown”). There is a possible association with disease severity and degree of hypercoagulability and hypofibrinolysis as a possible tool for risk stratification and the potential modulation of fibrinogen-dependent maximum clot firmness with enhanced anticoagulation strategies. Precisely how these coagulation abnormalities can be modified by optimum, individualised medical interventions to improve clinical outcomes, however, remains unclear.https://www.termedia.pl/The-role-of-rotational-thromboelastometry-in-understanding-the-coagulation-problems-in-COVID-19-associated-critical-illness,118,45270,1,1.htmlcoagulopathy rotem covid-19 critical care. |
| spellingShingle | Natalie Duric Tamas Szakmany The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illness Anaesthesiology Intensive Therapy coagulopathy rotem covid-19 critical care. |
| title | The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illness |
| title_full | The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illness |
| title_fullStr | The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illness |
| title_full_unstemmed | The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illness |
| title_short | The role of rotational thromboelastometry in understanding the coagulation problems in COVID-19 associated critical illness |
| title_sort | role of rotational thromboelastometry in understanding the coagulation problems in covid 19 associated critical illness |
| topic | coagulopathy rotem covid-19 critical care. |
| url | https://www.termedia.pl/The-role-of-rotational-thromboelastometry-in-understanding-the-coagulation-problems-in-COVID-19-associated-critical-illness,118,45270,1,1.html |
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