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Review

TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy

1
Mediclinic Stellenbosch, Stellenbosch 7600, South Africa
2
Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch 7602, South Africa
3
Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, UK
4
The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
*
Authors to whom correspondence should be addressed.
Academic Editors: Mark M. Walsh and Mirjam Bachler
J. Clin. Med. 2021, 10(22), 5381; https://doi.org/10.3390/jcm10225381
Received: 18 October 2021 / Revised: 11 November 2021 / Accepted: 15 November 2021 / Published: 18 November 2021
(This article belongs to the Special Issue Clinical Research on Viscoelastic Testing)
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. View Full-Text
Keywords: COVID-19; consumptive coagulopathy; platelets; blood clotting; fibrinolysis; von Willebrand factor COVID-19; consumptive coagulopathy; platelets; blood clotting; fibrinolysis; von Willebrand factor
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MDPI and ACS Style

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. https://doi.org/10.3390/jcm10225381

AMA Style

Laubscher GJ, Lourens PJ, Venter C, Kell DB, Pretorius E. TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy. Journal of Clinical Medicine. 2021; 10(22):5381. https://doi.org/10.3390/jcm10225381

Chicago/Turabian Style

Laubscher, Gert Jacobus, Petrus Johannes Lourens, Chantelle Venter, Douglas B Kell, and Etheresia Pretorius. 2021. "TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy" Journal of Clinical Medicine 10, no. 22: 5381. https://doi.org/10.3390/jcm10225381

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