63-D-Dimer and Fibrinogen Magnitude and Hypercoagulability by Thromboelastography in Severe COVID-19
Back to course
Video Transcription
Video Summary
Asset Subtitle
Hematology, Crisis Management, 2021
Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Abhimanyu Chandel, MD

Introduction/Hypothesis: Coronavirus disease 2019 (COVID-19) is associated with a high rate of thrombotic complications related to an acute inflammatory state. D-dimer has been established as a marker of disease severity in COVID-19. Despite a paucity of data, D-dimer concentration has been used by institutions to identify candidates for intensified anticoagulant treatment for prevention and mitigation of the thrombotic complications associated with COVID-19. Thromboelastography (TEG) maximum amplitude (MA) has been validated as a marker of hypercoagulability with previous research defining hypercoagulability by a TEG MA ≥ 68 mm. We examined the relationship between common clinical laboratory parameters and hypercoagulability as represented by TEG MA.

Methods: We performed a single center retrospective analysis of consecutive patients who received ECMO for the treatment of COVID-19 with simultaneous TEG, coagulation, and inflammatory markers (D-dimer, fibrinogen, ferritin, and C-reactive protein) drawn during hospitalization. TEG MA values and inflammatory markers were compared in patients with and without a thrombotic complication during admission. Correlation tests were performed to identify the coagulation and inflammatory markers that may predict hypercoagulability as defined by elevated TEG MA.

Results: 168 TEGs were available in 24 patients. C-reactive protein and fibrinogen were significantly higher in patients that developed a thrombotic event versus those that did not (p=0.038 and p=0.043 respectively). There was no difference in D-dimer between groups (p=0.312). D-dimer was negatively correlated with TEG MA (p<0.001) and explained little of the variance in this variable (adjusted R2=0.162). Fibrinogen was significantly positively correlated (p<0.001) with MA and explained over 50% of the variance. A fibrinogen > 441 mg/dL had high diagnostic accuracy (sensitivity of 91.2%, specificity of 85.7%) for the detection of MA ≥ 68 mm.

Conclusions: In critically ill patients with COVID-19, D-dimer had an inverse relationship with hypercoagulability as measured by TEG MA. D-dimer elevation may reflect severity of COVID-19 related sepsis rather than designate patients likely to benefit from anticoagulation. Fibrinogen concentration may represent a more useful marker of hypercoagulability in this population.


Meta Tag
Content Type Presentation
Knowledge Area Hematology
Knowledge Area Crisis Management
Knowledge Level Advanced
Membership Level Select
Tag COVID-19
Tag Coagulation
Year 2021
fibrinogen levels


Society of Critical Care Medicine

500 Midway Drive
Mount Prospect, IL 60056 USA

Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email: support@sccm.org

Contact Us

About SCCM


Advertising & Sponsorship




Patients & Families

Surviving Sepsis Campaign

Critical Care Societies Collaborative

kisspng-facebook-social-media-computer-icons-linkedin-soci-gray-5ac493cf1c2975.7867418415228323351154  - KW Symphony    Gray twitter 3 icon - Free gray social icons    Gray linkedin 3 icon - Free gray site logo icons    Gray instagram icon - Free gray social icons    YouTube Icon Gray Box - HONOR VETERANS NOW


© Society of Critical Care Medicine. All rights reserved.   |    Privacy Statement    |    Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.

Android App Download IOS App Download Powered By