ABSTRACT
Background : COVID-19 infection is associated with thrombosis and death, but the role of global coagulation assays such as thromboelastography (TEG) in predicting clinical outcomes is unclear. Aims : To assess TEG patterns in patients with COVID-19 and to determine association with mortality and thrombosis. Methods : TEGs were performed prospectively as part of a multicenter randomized controlled trial comparing standard vs intermediate dosing of prophylactic anticoagulation in hospitalized patients with severe COVID-19 (NCT04360824). All enrolled patients had a modified ISTH DIC score>3 and/or were admitted to an intensive care unit. TEG and baseline coagulation labs were obtained at study entry. TEG parameters and baseline labs and patient demographics were analyzed and correlated with the primary outcome (30-day mortality) and secondary outcomes (arterial and venous thrombosis, acute kidney injury, and major and minor bleeding). Results : The baseline characteristics for 131 patients for which TEG results were available are shown in Table 1. Thrombotic events occurred in 9.9% of patients ( N = 13), acute kidney injury in 13% ( N = 18) and the 30-day mortality rate was 16 % ( N = 21). No significant associations were noted between baseline TEG results and patient outcomes based on standard reference ranges. When comparing the continuous TEG data against relevant outcomes, only LY30 was associated with any outcome (30-day mortality). White blood cell count, D-dimer, and creatinine were better predictors of major patient outcomes. A multivariable model including categorical representations of age, LY30, and D-dimer values showed good performance in predicting 30-day mortality (Table 2). Conclusions : Hypercoagulability and thrombotic events occur frequently in hospitalized COVID-19 patients and are associated with adverse outcomes. TEG data independently was not predictive of major outcomes, but the addition of TEG results to a multivariate model improved prognostic implications for mortality.