ABSTRACT
Study Objectives: The primary objective of the study was to use thromboelastography (TEG) to evaluate coagulation dynamics in patients hospitalized with COVID-19 and to investigate TEG as a predictive tool for clinical course of infection. Methods: Adult patients admitted to Naval Medical Center Portsmouth with the diagnosis of SARS-CoV-2 were eligible for enrollment. TEG was performed on admission and trended daily with other laboratory tests through the hospitalization. Charts were reviewed for demographic, medical history, daily progress notes, clinical status, lab values, and anticoagulation medication use for each patient. Treatment teams were blinded to TEG values. Results: A total of 53 patients were enrolled, with three patients having two separate admissions. There were 31 males and 22 females with a mean age of 48. The preponderance of individual TEG components showed progression towards hypercoagulation as days of illness progressed, with 92% of subjects having at least one TEG value outside the reference range, even with the vast majority of patients receiving either therapeutic or prophylactic anticoagulants. The maximum amplitude (MA) and TEG coagulation indexes (CI) best correlated with day of illness (r = 0.45 and r = 0.32, respectively). Peak CI also correlated with length of hospital stay (r = 0.38). The majority (91%) remained hypercoagulable on discharge. Conclusions: The use of TEG measurements in those hospitalized at NMCP with COVID-19 infection confirms the hypercoagulable state previously reported in COVID-19 patients. It may have a role as a tool to predict clinical courses or to direct anticoagulation or antiplatelet therapy to reduce morbidity and mortality.