Complex and prolonged hypercoagulability in COVID-19 Intensive Care Unit patients: a thromboelastographic study

Abstract Background a high number of thrombotic complications have been reported in critically ill patients with COVID-19 and appear to be related to a hypercoagulable state. Evidence regarding detection, management, and monitoring of COVID-19-associated coagulopathy are still missing. We propose to describe the thrombus viscoelastic properties in order to investigate the mechanisms of hypercoagulability in COVID-19 patients. Methods thromboelastography (TEG) was performed in 24 consecutive patients admitted to a single intensive care unit (ICU) for COVID-19 pneumonia, and 10 had a second TEG before being discharged alive from the ICU. Results compared to a group of 20 healthy subjects, COVID-19 patients had significantly decreased values of R time, K time, and lysis index, and increased values of α angle, Maximum Amplitude, G and Coagulation Index. Velocity curves were consistent with increased generation of thrombin. These values persisted in surviving patients despite their good clinical course. Discussion in COVID-19 patients, TEG demonstrates a complex and prolonged hypercoagulable state including fast initiation of coagulation and clot reinforcement, low fibrinolysis, high potential of thrombin generation and high fibrinogen and platelet contribution. The antithrombotic strategy in COVID-19 patients during intensive care hospitalization and after discharge should be investigated in further studies.