Blood Clotting Anomalies Reveal Renal Failure Risk in COVID-19

Researchers at the University of Colorado Anschutz Medical Campus (CUAnshcutz; Aurora, USA) conducted a study that involved 44 intensive care unit (ICU) patients with COVID-19 diagnoses that underwent thromboelastography (TEG; a whole blood assay that provides a broad picture of how a patient’s blood forms clots, including clotting times, how strong the clots are, and how soon clots break down), as well as conventional coagulation assays, D-dimer levels, and viscoelastic parameters, all analyzed to predict thromboembolic outcomes and new onset renal failure.

The results showed that patients identified by TEG assays showing no clot breakdown after 30 minutes and a D-dimer level greater than 2600 ng/mL most often required hemodialysis and had a higher rate of clots in the veins. Overall, 80% of patients with both affirmative test findings were placed on dialysis, compared to 14% who tested for neither finding. Patients with affirmative test findings also had a 50% rate of venous blood clots compared with zero percent for those patients with neither finding. The study was published on May 8, 2020, in the Journal of the American College of Surgeons.

“Fibrinolysis shutdown, as evidenced by elevated D-Dimer and complete failure of clot lysis at 30 minutes on TEG, predicts thromboembolic events and need for hemodialysis in critically ill patients with COVID-19,” concluded lead author Franklin Wright, MD, and colleagues. “These study results suggest there may be a benefit to early TEG testing in institutions that have the technology to identify COVID-19 patients who may need more aggressive anticoagulation therapy to prevent complications from clot formation.”

Patients who are critically ill (regardless of cause) can develop a condition known as disseminated intravascular coagulation (DIC). The blood of these patients initially forms many clots in small blood vessels. The body’s natural clotting factors can form too many clots, and eventually may not be able to effectively form any more clots, leading to issues of both excessive clotting and excessive bleeding.

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University of Colorado Anschutz Medical Campus