Early Blood-Clotting Testing, Treatment Might Help Severe COVID-19 Patients
As knowledge on how to treat severe cases of COVID-19 increases exponentially, a lot of the focus now is on the role of blood clots in severe outcomes. Find out what a new study recommends about intensive testing and treatment with anticoagulation therapy to prevent complications.
AURORA, CO – Patients with more severe COVID-19 infection should undergo early blood-clotting tests and, if indicated, aggressive anticoagulation therapy to prevent complications, according to a new study.
An article on the Journal of the American College of Surgeons website bolsters growing evidence that COVID-19-infected patients are predisposed to developing blood clots. In this case, blood clotting measurements are linked with actual patient outcomes.
University of Colorado Anschutz Medical Campus-led researchers used a combination of two tests to determine that critically ill patients infected with COVID-19 were at high risk for developing renal failure, venous blood clots, and other complications associated with blood clots, such as stroke.
"This is an early step on the road to discovering treatments to prevent some of the complications that come with this disease," explained lead author Franklin Wright, MD, an assistant professor of surgery at the University of Colorado School of Medicine. "This study suggests that testing whole blood clotting measurements may allow physicians to identify and treat patients with COVID-19 more effectively to prevent complications and encourage further research into therapies to prevent blood clots in these patients.”
Background information in the article points out that critically ill patients, regardless of the cause, can develop disseminated intravascular coagulation (DIC), where many clots in small blood vessels are formed. In patients with COVID-19 the clotting appears to be especially severe, and, based on previous research, the clots don’t dissipate.
The researchers decided to use a specialized coagulation test -- thromboelastography (TEG) -- to examine clotting issues in COVID-19 patients. TEG, which is used primarily by surgeons and anesthesiologists to evaluate the efficiently of blood clotting, reveals how long clotting takes, how strong clots are, and how soon clots break down.
"The COVID pandemic is opening doors for multidisciplinary collaboration so trauma acute care surgeons and intensivists can bring the tools they use in their day-to-day lives and apply them in the critical care setting to new problems," Wright said.
The researchers evaluated outcomes for all patients who had a TEG assay as part of their treatment for COVID-19 infection as well as other conventional coagulation assays, including ones that measure D-dimer levels. D-dimer is a protein fragment that is produced when a blood clot dissolves. D-dimer levels are elevated when large numbers of clots are breaking down.
Researchers used a combination of the TEG assay and conventional coagulation tests, including those that measure D-dimer levels, in 44 patients treated for COVID-19 infection between March 22 and April 20 were included in the analysis. As a result, 80% of patients where TEG assays showed no clot breakdown after 30 minutes and where D-dimer levels were greater than 2600 ng/mL were placed on dialysis compared with 14% who tested for neither finding. Patients with affirmative test findings also had a 50 percent rate of venous blood clots compared with 0 percent for those patients with neither finding.
"These study results suggest there may be a benefit to early TEG testing in institutions that have the technology to identify COVID-19 patients who may need more aggressive anticoagulation therapy to prevent complications from clot formation," Wright point out.