Clinical utility of Thromboelastography in patients with COVID-19: a prospective observational study

Coronavirus disease (COVID-19) has been associated with thromboembolic and bleeding complications. Our study aims to understand the utility of early Thromboelastography (TEG) in the emergency department as a point-of-care test in predicting clinical outcomes. A prospective observational study was conducted in the emergency medicine department (ED) during June 2021- May 2022 with inclusion criteria of all patients above 18 years who arrived at the ED and had a positive COVID-19 RT PCR test. Hematological investigation, including TEG, was sent. Patients were followed up for 28-day mortality, thrombotic and bleeding complications. A total of 166 patients were enrolled in the study. 46% of patients had critical COVID-19. TEG was abnormal in 45% of patients. Hypercoagulability was seen in 32% of patients. 28-day mortality in our study population was 32.3%. The most common thrombotic complications were stroke (4.2%), myocardial infarction (3.6%), pulmonary embolism (1.2%), and DVT (0.6%). Logistic regression analysis showed that patients who had hypocoagulable TEG had a higher 28-day mortality. COVID-associated coagulopathy can be associated with both thrombotic (venous and arterial) and bleeding complications. Hypocoagulability on initial TEG has a 7.49 times increased risk of mortality. Hypocoagulable TEG indicates an early predictor for mortality. Early TEG can be an essential tool in managing COVID-associated coagulopathy.