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Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention

2022; Public Library of Science; Volume: 17; Issue: 1 Linguagem: Inglês

10.1371/journal.pone.0262600

1932-6203

Rodrigo Barbosa Aires, Alexandre A. de S. M. Soares, Ana Paula Monteiro Gomides, André Moraes Nicola, Andréa Teixeira−Carvalho, Dayde Lane M. da Silva, Eliana Teles de Gois, Flávia Dias Xavier, Francielle Pulcinelli Martins, Gabriela P. J. Santos, Heidi Luise Schulte, Isabelle Souza Luz, Laila Salmen Espíndola, Laurence Rodrigues do Amaral, Liza Felicori, Luciana Ansaneli Naves, Maíra R. M. de Carvalho, Matheus de Souza Gomes, Otávio Tolêdo Nóbrega, Patrícia Albuquerque, Wagner Fontes, Ciro Martins Gomes, Patrícia Shu Kurizky, Cleandro Pires de Albuquerque, Olindo Assis Martins‐Filho, Lícia Maria Henrique da Mota,

Blood properties and coagulation

In patients with severe forms of COVID-19, thromboelastometry has been reported to display a hypercoagulant pattern. However, an algorithm to differentiate severe COVID-19 patients from nonsevere patients and healthy controls based on thromboelastometry parameters has not been developed. Forty-one patients over 18 years of age with positive qRT-PCR for SARS-CoV-2 were classified according to the severity of the disease: nonsevere (NS, n = 20) or severe (S, n = 21). A healthy control (HC, n = 9) group was also examined. Blood samples from all participants were tested by extrinsic (EXTEM), intrinsic (INTEM), non-activated (NATEM) and functional assessment of fibrinogen (FIBTEM) assays of thromboelastometry. The thrombodynamic potential index (TPI) was also calculated. Severe COVID-19 patients exhibited a thromboelastometry profile with clear hypercoagulability, which was significantly different from the NS and HC groups. Nonsevere COVID-19 cases showed a trend to thrombotic pole. The NATEM test suggested that nonsevere and severe COVID-19 patients presented endogenous coagulation activation (reduced clotting time and clot formation time). TPI data were significantly different between the NS and S groups. The maximum clot firmness profile obtained by FIBTEM showed moderate/elevated accuracy to differentiate severe patients from NS and HC. A decision tree algorithm based on the FIBTEM-MCF profile was proposed to differentiate S from HC and NS. Thromboelastometric parameters are a useful tool to differentiate the coagulation profile of nonsevere and severe COVID-19 patients for therapeutic intervention purposes.