Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

M Hardy; T Lecompte; J Douxfils; S Lessire; J M Dogné; B Chatelain; S Testa; I Gouin-Thibault; Y Gruel; R L Medcalf; H Ten Cate; G Lippi; F Mullier

doi:10.1186/s12959-020-00230-1

Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

Thromb J. 2020 Sep 7:18:17. doi: 10.1186/s12959-020-00230-1. eCollection 2020.

Authors

M Hardy^{1

2}, T Lecompte³, J Douxfils^{4

5}, S Lessire², J M Dogné⁴, B Chatelain¹, S Testa⁶, I Gouin-Thibault⁷, Y Gruel⁸, R L Medcalf⁹, H Ten Cate¹⁰, G Lippi¹¹, F Mullier¹

Affiliations

¹ Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium.
² Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Anesthesiology Department, Yvoir, Belgium.
³ Département de Médecine, Hôpitaux Universitaires de Genève, service d'angiologie et d'hémostase et Faculté de Médecine Geneva Platelet Group (GpG), Université de Genève, Geneva, Suisse Switzerland.
⁴ Pharmacy Department, University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur, Belgium.
⁵ Qualiblood s.a, Namur, Belgium.
⁶ Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy.
⁷ Département d'Hématologie Biologique, INSERM, CIC 1414 (Centre d'Investigation Clinique de Rennes), Université de Rennes, CHU de Rennes, Rennes, France.
⁸ Laboratoire d'Hématologie-Hémostase, CHRU de Tours, Hôpital Trousseau, Tours, France.
⁹ Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria Australia.
¹⁰ Department of Internal Medicine, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.
¹¹ Section of Clinical Biochemistry, University of Verona, Verona, Italy.

Abstract

Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.

Keywords: Anticoagulation; COVID-19; Coagulopathy; D-dimers; Fibrinolysis; Hemostasis; Heparin; Thrombin generation; Thrombosis; Viscoelastic tests.

Publication types

Review