Abstract Number: PB0199
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: Venous thromboembolism (VTE) remains a significant complication of severe COVID-19 infection in spite of pharmacological thromboprophylaxis. Various coaguopathies including thrombocytopenia, thrombocytosis, DIC and fibrinolytic shutdown have been reported. Interpretation of isolated coagulation and fibrinolysis biomarkers can be complicated by septic states, disease severity and thrombo-inflammation. Thromboelastography (TEG) and Rotational Thromboelastography (ROTEM) are whole blood viscoelastic (VE) tests that provide rapid and full assessment of haemostasis process.
Aims: A systematic review and meta-analysis, to evaluate if TEG/ROTEM can help detect hypercoagulability and/or predict VTE risk in COVID-19 patients.
Methods: We searched MEDLINE, EMBASE, and EPUB Ahead of Print & Other Non-Indexed Citations (from inception to 18th October 2020). Studies included were observational or RCTs evaluating VE tests with COVID-19 infection. Review was registered with PROSPERO (CRD42021229814). 2 reviewers (SK, MO) reviewed all full-text versions of all eligible studies. Data abstracted on study design, demographic characteristics and clinical outcomes-VTE, mortality and laboratory tests and VE parameters. The effect estimates were expressed as odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval.
Results: We identified 153 articles (PRISMA in figure 1). A total of 841 patients from 20 selected studies (3 prospective,17 retrospective) were identified. 841 COVID-19 patients with 589 (70%)who had viscoelastic tests (10 ROTEM,10 TEG). 431 (73%) had elevated D-dimer. 293 (50%) patients were hypercoagulable on TEG/ROTEM and 245 (41%) normal. 3 studies reported fibrinolytic shutdown. 241 (29%) patients had VTE events. ROTEM showed a higher sensitivity (93%) and specificity (87%) compared to TEG with a sensitivity of 51% and specificity of 57%. The OR was 1.77 (95% CI: 0.62-to 5.04, I2= 57%, P= 0.29).
Conclusions: TEG®/ROTEM® can detect hypercoagulability in association with COVID19 coagulopathy but may not be sufficient to predict VTE. Clot mass and viscoelasticity (MCF in ROTEM or MA in TEG) appear to be the most critical parameters.
To cite this abstract in AMA style:
Kazi S, Noureldin A, Fainchtein K, Deng Y, Othman M. TEG/ROTEM: A Tool to Aid in the Diagnosis and Management of COVID 19 Coagulopathies – A Systematic Review [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/teg-rotem-a-tool-to-aid-in-the-diagnosis-and-management-of-covid-19-coagulopathies-a-systematic-review/. Accessed April 18, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/teg-rotem-a-tool-to-aid-in-the-diagnosis-and-management-of-covid-19-coagulopathies-a-systematic-review/