Evidence map›Paper›PMID 34742307›Full record

ArticleThrombosis journal2021

The evolution of clot strength in critically-ill COVID-19 patients: a prospective observational thromboelastography study.

Colette Neethling, Gregory Calligaro, Malcolm Miller, Jessica J S Opie

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Thrombosis journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.5field-weighted citation impact, top 33% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 7 citations in OpenAlex.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 1 country.

Colette NeethlingDepartment of Anaesthesia & Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Anzio Drive, Observatory, Cape Town, 7925, South Africa. neethling.colette@gmail.com.
Gregory CalligaroDivision of Pulmonology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
Malcolm MillerDepartment of Anaesthesia & Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Anzio Drive, Observatory, Cape Town, 7925, South Africa.
Jessica J S OpieDivision of Haematology, Department of Pathology, University of Cape Town & National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
Groote Schuur Hospital · ZANational Health Laboratory Service · ZAUniversity of Cape Town · ZA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFew studies detail the evolution of COVID-19 associated coagulopathy. We performed serial thromboelastography (TEG) and laboratory coagulation studies in 40 critically-ill, mechanically ventilated COVID-19 patients over a 14-day period and analysed differences between 30-day survivors and non-survivors.

methodsSingle-center prospective, observational study including 40 patients with severe COVID-19 pneumonia admitted to the intensive care unit (ICU) for mechanical ventilation. TEG analysis was performed on days 1, 7 and 14 of ICU admission and laboratory coagulation studies were performed on days 1 and 14. Coagulation variables were evaluated for change over the 14-day observation period. Differences between survivors and non-survivors at 30-days were analysed and compared.

resultsOn admission, TEG maximum amplitude (MA) with heparinase correction was above the upper limit of the reference range in 32 (80%) patients while 33 (82.5%) presented with absent clot lysis at 30 min. The functional fibrinogen MA was also elevated above the upper limit of the reference range in 37 (92.5%) patients. All patients had elevated D-dimer and fibrinogen levels, mildly prolonged prothrombin times (PT), normal platelet counts and normal activated partial thromboplastin times (aPTT). The heparinase MA decreased significantly with time and normalised after 14 days (p = < 0.001) while the increased fibrin contribution to clot strength persisted with time (p = 0.113). No significant differences in TEG analysis were noted between 30-day survivors and non-survivors at all time points. No patients developed disseminated intravascular coagulopathy (DIC) after 14-days, however thrombosis and bleeding were each reported in 3 (7.5%) patients.

conclusionCritically-ill patients with COVID-19 present in a hypercoagulable state characterised by an increased clot strength. This state normalises after 14 days despite a persistently increased fibrin contribution to clot strength. We were unable to demonstrate any significant differences in TEG parameters between 30-day survivors and non-survivors at all time points.

Indexed as

Acute respiratory distress syndrome (ARDS)Corona virus disease 2019 (COVID-19)COVID-19 coagulopathyCritically-illHypercoagulabilityThromboelastography (TEG)

Identifiers

PMID34742307
PMCPMC8572064
OpenAlexW3214396442

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.