Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population
Introduction. The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood a...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-01-01
|
| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2021/3935098 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832551604065140736 |
|---|---|
| author | Sarah Alexandra van Blydenstein Colin Nigel Menezes Nicole Miller Naomi Johnson Bavinash Pillay Barry F. Jacobson Shahed Omar |
| author_facet | Sarah Alexandra van Blydenstein Colin Nigel Menezes Nicole Miller Naomi Johnson Bavinash Pillay Barry F. Jacobson Shahed Omar |
| author_sort | Sarah Alexandra van Blydenstein |
| collection | DOAJ |
| description | Introduction. The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient. Methods. A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (n = 26) were women. The median age was 61 (IQR 50–67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18–30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46–0.62), whilst 29/41 (0.71, CI 0.64–0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower (p ˂ 0,01), and the α-angle (p ˂ 0,01) and maximum amplitude (MA) (p ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively. Conclusions. In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy. |
| format | Article |
| id | doaj-art-46c315ffc06e4a759db67d2d751a2a34 |
| institution | Kabale University |
| issn | 2090-1313 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-46c315ffc06e4a759db67d2d751a2a342025-02-03T06:01:00ZengWileyCritical Care Research and Practice2090-13132021-01-01202110.1155/2021/3935098Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African PopulationSarah Alexandra van Blydenstein0Colin Nigel Menezes1Nicole Miller2Naomi Johnson3Bavinash Pillay4Barry F. Jacobson5Shahed Omar6Division of PulmonologyDivision of Infectious DiseasesDepartment of Internal MedicineDepartment of Internal MedicineDepartment of Internal MedicineDepartment of Molecular Medicine and HaematologyDepartment of Critical CareIntroduction. The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient. Methods. A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (n = 26) were women. The median age was 61 (IQR 50–67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18–30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46–0.62), whilst 29/41 (0.71, CI 0.64–0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower (p ˂ 0,01), and the α-angle (p ˂ 0,01) and maximum amplitude (MA) (p ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively. Conclusions. In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.http://dx.doi.org/10.1155/2021/3935098 |
| spellingShingle | Sarah Alexandra van Blydenstein Colin Nigel Menezes Nicole Miller Naomi Johnson Bavinash Pillay Barry F. Jacobson Shahed Omar Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population Critical Care Research and Practice |
| title | Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population |
| title_full | Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population |
| title_fullStr | Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population |
| title_full_unstemmed | Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population |
| title_short | Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population |
| title_sort | prevalence and trajectory of covid 19 associated hypercoagulability using serial thromboelastography in a south african population |
| url | http://dx.doi.org/10.1155/2021/3935098 |
| work_keys_str_mv | AT sarahalexandravanblydenstein prevalenceandtrajectoryofcovid19associatedhypercoagulabilityusingserialthromboelastographyinasouthafricanpopulation AT colinnigelmenezes prevalenceandtrajectoryofcovid19associatedhypercoagulabilityusingserialthromboelastographyinasouthafricanpopulation AT nicolemiller prevalenceandtrajectoryofcovid19associatedhypercoagulabilityusingserialthromboelastographyinasouthafricanpopulation AT naomijohnson prevalenceandtrajectoryofcovid19associatedhypercoagulabilityusingserialthromboelastographyinasouthafricanpopulation AT bavinashpillay prevalenceandtrajectoryofcovid19associatedhypercoagulabilityusingserialthromboelastographyinasouthafricanpopulation AT barryfjacobson prevalenceandtrajectoryofcovid19associatedhypercoagulabilityusingserialthromboelastographyinasouthafricanpopulation AT shahedomar prevalenceandtrajectoryofcovid19associatedhypercoagulabilityusingserialthromboelastographyinasouthafricanpopulation |