Laubscher, Gert Jacobus, Lourens, Petrus Johannes, Venter, Chantelle, Kell, Douglas B 
ORCID: 0000-0001-5838-7963 and Pretorius, Etheresia
(2021)
TEG(R), Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy.
JOURNAL OF CLINICAL MEDICINE, 10 (22).
5381-.
Abstract
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<sup>®</sup> (TEG<sup>®</sup>)) 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<sup>®</sup>, 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<sup>®</sup>, might be used as a guideline for disease severity. A multi-pronged approach, guided by TEG<sup>®</sup> and platelet mapping, would be required to maintain normal clotting physiology in severe COVID-19 disease.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | COVID-19, consumptive coagulopathy, platelets, blood clotting, fibrinolysis, von Willebrand factor |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 18 Jan 2022 09:34 |
| Last Modified: | 06 Feb 2024 17:29 |
| DOI: | 10.3390/jcm10225381 |
| Open Access URL: | https://doi.org/10.3390/jcm10225381 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3147086 |
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