Evaluation of coagulation status using viscoelastic testing in intensive care patients with coronavirus disease 2019 (COVID-19): An observational point prevalence cohort study.
Luke Wallace Collett, Samuel Gluck, Richard Michael Strickland and 1 others
PMID 32773357WHAT IT FOUND
Clot testing showed abnormally firm clots in six ventilated ICU patients with COVID-19, despite mostly normal routine clotting tests.
This suggests a high clotting tendency, but the study is too small to guide treatment.
Key findings
01In the six patients, clot testing showed abnormally firm clots and minimal clot breakdown.
02Routine clotting tests were within normal limits except for elevated fibrinogen and D-dimer.
03No patient had known arterial or venous thrombosis at testing, but two later developed venous thromboembolism.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only six patients were studied at one hospital, so the results cannot show how common this pattern is or whether it applies to other intensive care patients. There was no control group, so prolonged critical illness, immobility, and comorbidity cannot be separated from COVID-19 itself. Deep vein thrombosis screening was not routinely done, so some thromboembolic events may have been missed. Testing occurred a median of 14 days after intensive care admission, so the findings do not describe coagulation early in ICU stay. All patients were receiving enoxaparin 40 mg subcutaneously daily, so the clotting pattern was seen despite thromboprophylaxis, and the study did not test whether changing anticoagulation helps.
Declared interests
The study did not receive specific grant funding, and the authors declared no competing interests.
The easy way to misread this
Do not conclude that normal PT, INR, aPTT, or platelet counts mean a patient is not at risk of clotting, or that clot testing should guide anticoagulation. The study included only six patients, had no control group, and did not test whether acting on the results changes outcomes.