Rotational Thromboelastometry Profile among Critically ill COVID-19 Patients

Authors

Romein W G Dujardin, Department of Intensive Care OLVG Hospital Amsterdam The Netherlands., Laboratory of Experimental Intensive Care and Anesthesiology Amsterdam UMC Amsterdam The Netherlands
Gabriel Gacria Rosenbaum, Department of Internal Medicine University of New Mexico School of Medicine Albuquerque New Mexico USA
Jecko Thachil, Department of Haematology Manchester Royal Infirmary Manchester UK
Nathan D. Nielsen, Division of Pulmonary, Critical Care and Sleep Medicine University of New Mexico School of Medicine Albuquerque New Mexico USA, Department of Pathology University of New Mexico School of Medicine Albuquerque New Mexico USA
Nicole P. Juffermans, Department of Intensive Care OLVG Hospital Amsterdam The Netherlands, Laboratory of Experimental Intensive Care and Anesthesiology Amsterdam UMC Amsterdam The Netherlands.

Document Type

Article

Publication Date

9-2022

Abstract

Background: Critically ill COVID-19 patients are in a hypercoagulable state with increased risk of thrombotic complications. Rotational thromboelastometry (ROTEM) is a viscoelastic test with the potential to reflect COVID-19-associated hypercoagulability and may therefore be useful to predict thrombotic complications.

Objective: To investigate the potential of ROTEM profiles to predict thrombotic complications in critically ill COVID-19 patients.

Patients/methods: Retrospective multicenter cohort study in 113 adult patients with confirmed COVID-19 infection admitted to the intensive care unit (ICU) of two large teaching hospitals in the United States and in the Netherlands. ROTEM profiles of the EXTEM, INTEM, and FIBTEM tracings were measured within 72 h of ICU admission. Thrombotic complications encompass both arterial and venous thromboembolic complications, diagnosed with electrocardiogram, ultrasound, or computed tomography. ROTEM profiles were compared between patients with and without thrombosis. Univariable logistic regression followed by receiver operating characteristic (ROC) curves analysis was performed to identify ROTEM parameters associated with thrombosis.

Results and conclusions: Of 113 patients, 27 (23.9%) developed a thrombotic event. In the univariable analysis, EXTEM clot amplitude at 10 min (CA10) and EXTEM maximum clot formation (MCF) were associated with thrombosis with a p < 0.2 (p = 0.07 and p = 0.05, respectively). In ROC curve analysis, EXTEM CA10 had an area under the curve (AUC) of 0.58 (95% CI 0.47-0.70) and EXTEM MCF had an AUC of 0.60 (95% CI 0.49-0.71). Thereby, ROTEM profiles at ICU admission did not have the potential to differentiate between patients with a high and low risk for thrombotic complications.

Recommended Citation

Dujardin RWG, Garcia Rosenbaum G, Klercq TCJ, Thachil J, Nielsen ND, Juffermans NP. Rotational thromboelastometry in critically ill COVID-19 patients does not predict thrombosis. Res Pract Thromb Haemost. 2022 Sep 6;6(6):e12798. doi: 10.1002/rth2.12798. PMID: 36090158; PMCID: PMC9448874.