Natural Compounds in Clot Waveform Analysis and D-Dimer Modulation: Implications for COVID-19 Diagnosis and Prognosis

Objectives: Patients diagnosed with coronavirus disease (COVID-19) may develop hypercoagulopathy. A thromboelastogram can detect hypercoagulopathy, but it is not commonly available in all healthcare facilities. Understanding the clot waveform analysis (CWA) parameters of the CS-2500 coagulation analyzer in patients diagnosed with COVID-19 may help determine whether it can serve as an alternative. Methods: This study measured the amounts of activated partial thromboplastin time (aPTT)-based CWA, aPTT, plasma prothrombin time (PPT), and D-dimer using the CS-2500 autoanalyzer in 177 patients confirmed with COVID-19 and 110 patients without COVID-19. Retrospective data collection was conducted using electronic medical records. COVID-19 and non-COVID-19 were distinguished by the SARS-COV-2 PCR results. Results: Substantial differences were observed in the aPTT-based CWA parameters, including maximum coagulation velocity (Vmax), maximum coagulation acceleration (Amax), and maximum coagulation deceleration (Dmax) (p = 0.03, p = 0.03, and p = 0.02), between the COVID-19 and non-COVID-19 groups but not between survivors and non-survivors. Additionally, a substantial difference was identified in the D-dimer between the two groups (p = 0.002 and p < 0.001). The difference in D-dimer between both groups could be explained by the fact that non-survivors have a more prominent hypercoagulable state. Conclusions: While the D-dimer may be a better indicator of mortality in COVID-19 patients, the aPTT-based CWA characteristics may be more helpful in differentiating between COVID-19 and non-COVID-19 patients. Further investigations on treatment interference and the specificity of this method to predict hypercoagulable states are warranted.