Tejpal Karna Sunaina, Singh Pooja, Ahmad Haq Zainab, Jain Gaurav, Khurana Alkesh, Saigal Saurabh, Prakash Sharma Jai, Waindeskar Vaishali
Department of Anaesthesiology and Critical Care, AIIMS, Bhopal, India.
Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, India.
Turk J Anaesthesiol Reanim. 2022 Oct;50(5):332-339. doi: 10.5152/TJAR.2021.21118.
Thromboelastography and rotational thromboelastometry are the viscoelastic point of care devices that use whole blood samples to assess coagulation and fibrinolysis. These devices give information from initiation of the coagulation cascade, activation of clotting factors to fibrin cross-linking, and contribution of fibrinogen and platelet to clot strength and clot lysis. Viscoelastic point of care tests are well established in hypocoaguable states like trauma, cardiac surgery, liver transplantation, and their use in critical care settings with coronavirus disease 2019 (COVID-19) is not so well-known. We performed a systematic review of studies on thromboelastography and rotational thromboelastometry and their modifications to assess their role in critically ill patients with COVID-19. Inclusion criteria were any kind of studies using thromboelastography or rotational thromboelastometry during coronavirus disease critical illness published in English. Ninety-three articles, from December 1, 2019, to August 31, 2020, were identified in the initial search, out of which 12 articles (a total of 380 patients) satisfied the inclusion and exclusion criteria. Thromboelastography and rotational thromboelastometry were observed to detect the hypercoagulable changes and fibrinolysis shutdown associated with COVID-19. Hypercoagulability is associated with an increased risk of venous thrombosis and micro-thrombosis. This review identifies the role of thromboelastography and rotational thromboelastometry in studying the mechanisms contributing to coagulopathy and incidence of thrombosis in COVID-19.
血栓弹力图和旋转血栓弹力测定法是即时检测的粘弹性设备，它们使用全血样本评估凝血和纤维蛋白溶解情况。这些设备能够提供从凝血级联反应启动、凝血因子激活到纤维蛋白交联，以及纤维蛋白原和血小板对血凝块强度及血凝块溶解作用等方面的信息。即时检测的粘弹性检测在诸如创伤、心脏手术、肝移植等低凝状态中已得到广泛应用，但其在2019冠状病毒病（COVID-19）重症监护环境中的应用却鲜为人知。我们对有关血栓弹力图和旋转血栓弹力测定法及其改进方法的研究进行了系统综述，以评估它们在COVID-19重症患者中的作用。纳入标准为在冠状病毒病危重症期间使用血栓弹力图或旋转血栓弹力测定法的任何类型的英文发表研究。在初步检索中，我们共识别出93篇文章（发表时间为2019年12月1日至2020年8月31日），其中12篇文章（共380例患者）符合纳入和排除标准。研究发现，血栓弹力图和旋转血栓弹力测定法能够检测出与COVID-19相关的高凝变化和纤维蛋白溶解停止情况。高凝状态与静脉血栓形成和微血栓形成风险增加有关。本综述确定了血栓弹力图和旋转血栓弹力测定法在研究COVID-19凝血功能障碍机制及血栓形成发生率方面的作用。
