TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy
Date
2021-11
Journal Title
Journal ISSN
Volume Title
Publisher
MDPI
Abstract
An important component of severe COVID-19 disease is virus-induced endothelilitis. This
leads to disruption of normal endothelial function, initiating a state of failing normal clotting physiology.
Massively increased levels of von Willebrand Factor (VWF) lead to overwhelming platelet
activation, as well as activation of the enzymatic (intrinsic) clotting pathway. In addition, there is
an impaired fibrinolysis, caused by, amongst others, increased levels of alpha-(2) antiplasmin. The
end result is hypercoagulation (proven by thromboelastography® (TEG®)) and reduced fibrinolysis,
inevitably leading to a difficult-to-overcome hypercoagulated physiological state. Platelets in
circulation also plays a significant role in clot formation, but they themselves may also drive hypercoagulation
when they are overactivated due to the interactions of their receptors with the endothelium,
immune cells or circulating inflammatory molecules. From the literature it is clear that the role of
platelets in severely ill COVID-19 patients has been markedly underestimated or even ignored. We
here highlight the value of early management of severe COVID-19 coagulopathy as guided by TEG®,
microclot and platelet mapping. We also argue that the failure of clinical trials, where the efficacy of
prophylactic versus therapeutic clexane (low molecular weight heparin (LMWH)) were not always
successful, which may be because the significant role of platelet activation was not taken into account
during the planning of the trial. We conclude that, because of the overwhelming alteration of clotting,
the outcome of any trial evaluating an any single anticoagulant, including thrombolytic, would be
negative. Here we suggest the use of the degree of platelet dysfunction and presence of microclots in
circulation, together with TEG®, might be used as a guideline for disease severity. A multi-pronged
approach, guided by TEG® and platelet mapping, would be required to maintain normal clotting
physiology in severe COVID-19 disease.
Description
CITATION: Laubscher, G.J.; Lourens, P.J.; Venter, C.; Kell, D.B.; Pretorius, E. TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy. J. Clin. Med. 2021, 10,
5381. doi.10.3390/jcm10225381
The original publication is available at: mdpi.com
The original publication is available at: mdpi.com
Keywords
Blood -- Coagulation, Blood coagulation disorders, Blood platelets, COVID-19 (Disease) -- Complications, Von Willebrand factor
Citation
Laubscher, G.J.; Lourens, P.J.; Venter, C.; Kell, D.B.; Pretorius, E. TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy. J. Clin. Med. 2021, 10,
5381. doi.10.3390/jcm10225381