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

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

doi:10.1186/s12959-020-00230-1

Thrombosis Journal

Table 2 Indications and limitations of tests available in the hemostasis laboratory

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

	Main Limitations	Indications in COVID-19
	Main Limitations	Evaluation of the thrombotic risk	Screening of thromboembolic events	Prognosis: disease severity	Diagnosis of DIC	Detection of HIT	Monitoring of unfractionated heparin
Platelet count	Many causes of thrombocytopenia in the critically ill patient			X	X	X
APTT	Major influence of preanalytical step					X (*)	X
APTT	Differences of APTT reagents in their sensitivity to unfractionated heparin, lupus anticoagulant and inflammatory syndrome					X (*)	X
Prothrombin Time	Influence of the preanalytical step				X
Prothrombin Time	Influence of fibrinogen level				X
Fibrinogen (Clauss)	Lack of sensitivity for the diagnosis of DIC (mostly in infectious/inflammatory setting)	X		X	X
Fibrinogen (Clauss)	Possibility of interference of direct thrombin inhibitors with some reagents	X		X	X
D-dimers	Decreased analytical performances in high D-dimers values	X	X	X	X
	Production dependent on the fibrinolytic activity
	Cut-offs non commutable between reagents
Soluble fibrin complexes (AKA ‘Fibrin monomers’)	Preliminary validation only		X		X
	Not evaluated in COVID-19
	Cut-offs non commutable between the reagents
Fibrinolysis capacity tests	Fibrinolysis is assessed in non-physiological conditions	X		X
	Large array of methods
	Not evaluated in COVID-19
Anti-Xa activity	Inter-reagent variability						X
	Influence of presence/absence of exogenous AT in the reagent
	Expensive
	Only available 24 h a day 7 days a week in a fraction centers
Viscoelastic tests	Not evaluated in COVID-19	X		X			X
	Lack of standardization between instruments and centers
	Expensive
Thrombin generation assays	Not evaluated in COVID-19	X
	High sensitivity to heparins
	Limited availability in clinical practice
	Expensive

(*) Heparin resistance can be due to HIT.
Note: the assessment of the in vivo effect of (any) anticoagulant treatment could be assisted with the monitoring of fibrin-related markers (D-dimers; fibrin monomers)

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ISSN: 1477-9560

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