This manuscript evaluates the application of global assays of haemostasis in mechanically ventilated COVID-19 patients. The results presented here originate from the serial rotational thromboelastometry (ROTEM) and thrombin generation measurements in the Maastricht Intensive Care COVID (MaastrICCht) cohort. Routine and tissue plasminogen activated (tPA) ROTEM were able to characterise the complex haemostatic abnormalities in this population over time and deceased COVID-19 patients demonstrate further deterioration of the observed hypercoagulability and hypofibrinolysis. Furthermore, thrombin generation assays suggest a limited in vivo heparin anticoagulant effect; whereas routine laboratory assays (anti-Xa) generally fell within the heparin-therapeutic range. In summary, global assays of haemostasis may be suitable to quantify the heparin anticoagulant effect and to characterise complex haemostatic pathologies in an ICU setting. However, more research focused on the prognostic value and application in non-COVID ICU patients is required prior to clinical implementation.

(BELG J HEMATOL 2024;15(2):43–8)