Investigation of coagulation profiles of COVID-19 patients who require intensive care admission under routine anticoagulation therapy by rotational thromboelastometry

Aim: COVID-19 was first identified in China in December 2019, rapidly affected the whole world, and was defined as a COVID-19 pandemic by the World Health Organization. Pulmonary damage is not the only cause of death due to this virus, which mainly colonizes the respiratory tract, has been shown by the presence of arterial and venous thrombosis in studies, and it has been stated that patients are at risk of thrombosis in addition to hypoxia and hyperinflammation. Changes in the thrombotic/fibrinolytic balance at the endothelial level affect the cerebral, renal and peripheral circulation, including the pulmonary circulation, and pave the way for thrombosis. The deficiencies in the ability of the conventional coagulation tests used in the routine to reflect the disorders that occur in the coagulation process maintain their importance in the current literature. ROTEM, one of the viscoelastic tests used today, is a test that can simultaneously evaluate the steps of the coagulation process. Under these circumstances, the critical question is whether the use of viscoelastic methods in this clinical setting will help to better assess coagulopathy, predict thrombotic events, or guide anticoagulant therapy. In the light of current literature data, it is revealed that viscoelastic tests provide more comprehensive coagulopathy evaluation than conventional coagulation tests in COVID-19 patients and can identify both sides of coagulopathy such as hypercoagulation and hypofibrinolysis. The aim of this study is to evaluate coagulation disorders and fibrinolytic activities of patients with COVID-19 infection followed in the intensive care unit, despite standardized anticoagulant and antiplatelet therapy, with ROTEM. Materials and Methods: Our study was designed as a single-center retrospective study. 35 patients who were hospitalized and followed up in the intensive care unit due to COVID-19 between 01.01.2021 and 31.12.2021 were included in the study. Age, gender, and additional diseases of the patients were recorded, admission to the intensive care unit was accepted as the 1st day, and data between days 1-10 were collected. In addition to the laboratory data, the oxygenation and ventilation supports performed during the follow-up were recorded. The daily calculated APACHE, SOFA, DIC and SIC scores of the patients were examined, and the ROTEM values studied from the patients on the 1st, 5th and 10th days were obtained from the system. EXTEM CT/CFT/MCF/ML, INTEM CT/CFT/MCF/ML, FIBTEM CT/CFT/MCF/ML values from ROTEM parameters were included to the study. All collected parameters were examined for their association with mortality in addition to the coagulation status of the patients. Results:In our study, there were a total of 35 patients, 17 women (48.6%) and 18 men (51.4%), who had positive COVID-19 PCR tests and needed intensive care follow-up. The mean age of patients was 62.71±18.52. Of the 35 patients followed in our study, 14 died during the follow-up period or while hospitalized in the intensive care unit after the follow-up period. When the ROTEM parameters of the patients were examined, the mean FIBTEM MCF value was higher than the upper limit of 25 mm in all measurements. At admission, 71.4 percent of patients had FIBTEM MCF values above the upper limit. When the mean MCF values were compared, it was seen that hypercoagulation was more pronounced in FIBTEM than in EXTEM and INTEM. In our study, it was concluded that high SOFA score, DIC score, INR, procalcitonin, and lactate levels observed during admission are associated with mortality. It was concluded that parameters other than FIBTEM ML and INTEM ML parameters were not associated with mortality. Conclusions: Patients requiring intensive care admission due to COVID-19 are prone to hypercoagulation secondary to endothelial damage and widespread inflammation. The deficiencies of routine conventional tests in detecting hypercoagulation observed in COVID-19 patients can be eliminated with ROTEM. In addition, SOFA score, DIC score, INR, lymphocyte count, and lactate level are parameters associated with mortality in COVID-19 patients.