Illustration: Thromboelastography – A useful tool to monitor COVID-19-associated coagulopathy

Ashwinkumar Vaidya; Bemma Paonam; Ganesh Mohan; Shamee Shastry

doi:10.4103/ajts.ajts_73_21

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Year : 2022 | Volume : 16 | Issue : 1 | Page : 148-149

Illustration: Thromboelastography – A useful tool to monitor COVID-19-associated coagulopathy

Ashwinkumar Vaidya, Bemma Paonam, Ganesh Mohan, Shamee Shastry
Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

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Date of Submission	12-Jun-2021
Date of Decision	04-Jul-2021
Date of Acceptance	18-Jul-2021
Date of Web Publication	30-Jul-2022

Abstract

COVID 19 is caused by Severe Acute Respiratory Syndrome Corona Virus-2 which results in wide range of manifestations. Systemic hypercoagulation is a typical feature of COVID-19. We present a case of COVID-19 in whom TEG was performed on admission and hypercoagulability was diagnosed and hence patient was started on Enoxaparin sodium 6000 IU twice daily. TEG was repeated after 5 days which showed normal coagulation status and the patient was discharged without any thrombotic complications.

Keywords: Coagulopathy, COVID19, Haemostasis, TEG

How to cite this article:
Vaidya A, Paonam B, Mohan G, Shastry S. Illustration: Thromboelastography – A useful tool to monitor COVID-19-associated coagulopathy. Asian J Transfus Sci 2022;16:148-9

How to cite this URL:
Vaidya A, Paonam B, Mohan G, Shastry S. Illustration: Thromboelastography – A useful tool to monitor COVID-19-associated coagulopathy. Asian J Transfus Sci [serial online] 2022 [cited 2022 Aug 8];16:148-9. Available from: https://www.ajts.org/text.asp?2022/16/1/148/353028

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 infection which is characterized by acute respiratory distress like clinical picture with a profound predilection for hypercoagulation. Hypercoagulability leads to an increased risk of thromboembolic events such as deep vein thrombosis, pulmonary thromboembolism, acute stroke, and acute myocardial infarction.^[1] Hence, the guidelines recommend the use of anticoagulation of patients upon hospital admission.^[2]

Short Report

A 68-year-old female presented with fever, easy fatiguability, cough, and dyspnea. On examination, SpO2 was 82% at room air, blood pressure was 104/62 mmHg, and pulse rate was 73 beats/min. The routine laboratory testing was sent along with thromboelastography (TEG; TEG 5000, Haemonetics). Her laboratory parameters on admission were hemoglobin of 7.3 g/dl (12–15), platelet count of 280 × 10³/μl (150–400), prothrombin time (PT) –11.9 s (9.6–12.5), activated partial thromboplastin time (aPTT) –28.5 s (26.8–33.2), and D-dimer of >9 μg/ml (<0.5 μg/mL). The patient was diagnosed with severe COVID-19 and was put on a mechanical ventilator with inotropic support. The first TEG was done on the day of admission [Figure 1] which clearly showed features of hypercoagulable state in clot initiation (R time), amplification (K time and alpha angle), and progression (MA [Maximum amplitude] and CI [Coagulation Index]). Based on TEG, the patient was started on injection enoxaparin sodium 6000 IU twice daily for 5 days.

Figure 1: Thromboelastography showing hypercoagulable state on admission

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A normal TEG tracing was obtained when repeated after 5 days while the patient was still in intensive care unit [Figure 2]. The patient improved without developing any thromboembolic events and was discharged on day 9 from hospital. Even though D-dimer is specific for an ongoing thromboembolism, it is highly elevated in COVID-19 infections or severe inflammatory response even without a thromboembolic complication.^[3] Early identification of hypercoagulable state can be done using TEG, which otherwise might be difficult to diagnose using conventional coagulation screens such as PT, aPTT, fibrinogen, and D-dimer.

Figure 2: Repeat thromboelastography on day 5

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Loo J, Spittle DA, Newnham M. COVID-19, immunothrombosis and venous thromboembolism: Biological mechanisms. Thorax. BMJ Publishing Group 2021;76:412-20.
2.	Carfora V, Spiniello G, Ricciolino R, Di Mauro M, Migliaccio MG, Mottola FF, et al. Anticoagulant treatment in COVID-19: A narrative review. J Thromb Thrombolysis Springer 2021;51:642-8.
3.	Thachil J. All those D-dimers in COVID-19. J Thromb Haemost 2020;18:2075-6.