Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

The Role of Rotational Thromboelastometry (ROTEM) in Understanding the Coagulation Problems in COVID-19 Associated Critical Illness

Version 1 : Received: 30 January 2021 / Approved: 1 February 2021 / Online: 1 February 2021 (17:34:13 CET)

A peer-reviewed article of this Preprint also exists.

Journal reference: Anaesthesiol Intensive Ther 2021, 53
DOI: 10.5114/ait.2021.109401

Abstract

In critically ill patients with COVID-19, concomitant abnormalities of coagulation have been seen with an unusually high incidence. Standard coagulation tests are limited in their ability accurately to reflect the severity of the pro-thrombotic phenotype observed in severe COVID-19 infections. In this narrative review we consider the role of rotational thromboelastometry (ROTEM) as a near bedside test allowing a more comprehensive assessment of haemostatic function in the context of COVID-19 infection. Comprehensive literature search was conducted on PubMed, revealing 13 publications on the subject. The coagulopathy of this disease process appears to be insufficiently represented with often normal conventional coagulation test parameters. Whilst not the perfect substitute for in vivo coagulation, studies utilising rotational thromboelastometry assays in COVID-19 patients have demonstrated increased maximum clot firmness (consistent with hyper-coagulability) and reduced maximum lysis (consistent with “fibrinolytic shutdown”). ROTEM appears to be a possible tool for risk stratification and to monitor the potential modulation of fibrinogen-dependent coagulation processes with enhanced anti-coagulation strategies. Precisely how these coagulation abnormalities can be modified by optimum, individualised medical interventions to improve clinical outcome, however, remains unclear.

Keywords

ROTEM; COVID-19; coagulation

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