Since the onset of the COVID-19 pandemic, mounting evidence has shown that patients with severe infection are more likely to have COVID-associated coagulopathies. The global coagulation community responded rapidly with various societies reviewing available data and providing recommendations and educational resources [1]. Researchers also spearheaded a multi-platform randomised trial to support the community to make better decisions in management of hospitalised COVID-19 patients.

With the introduction of COVID-19 vaccination programmes, blood clots associated with adenovirus-based COVID vaccines—a condition known as Vaccine Induced Thrombotic Thrombocytopenic (VITT)—emerged as a new area of concern. Here too, the coagulation community responded rapidly by developing diagnostic and management guidelines for this rare but serious condition. It also supported public communication campaigns to share facts related to VITT and the importance of vaccination in our war with COVID-19 [2].

Below are four ways that clinical labs and clinicians worked hand in hand to address the coagulopathy challenges related to COVID infection and vaccination.

Continued lab-clinician collaboration in coagulation research

Even before the pandemic, coagulation has always been a discipline in which both clinical observations and laboratory testing complement each other very closely. From diagnosis to management, clinical lab services have always played a crucial role providing insights to clinicians. Together with clinical observations, these services shape the treatment and monitoring regimes for patients. In the case of COVID-19, laboratory data insights has consistently been the driver of major findings and key developments in our understanding of COVID-related coagulopathies, including VITT [3].

Improving outcomes for patients on anticoagulants

Thromboembolism has been well understood and managed using anticoagulants in the coagulation community for a long time. This raises a question if changing the dosage of an anticoagulant regimen can improve the outlook for severe COVID-19 patients. With the commencement of an international, multi-platform randomised clinical trial, researchers are striving to provide an answer quickly to this question. This collaboration is novel in the field of anticoagulation research, driven by the common purpose of allowing the community to assess what is the best treatment strategy to deploy for the vulnerable patients [4].

Patient engagement and public health activism

With the emergence of VITT, there is also an increasing need for the coagulation community to play a more active role in public health and patient education. Addressing the concerns of patients is already a routine practice for many leaders in the community [5]. By reaching out to the public and communicating scientific facts and consistent messaging, the public is empowered to make more informed decisions [6].

New ways of working

The International Society on Thrombosis and Haemostasis (ISTH) COVID-19 Task Force that was formed before mid-2020 helped steer the direction of the coagulation community during the different phases of the pandemic. Alongside other societies, it shared clear guidelines and relevant contents. Its members’ willingness to collaborate allowed clinical trials to be completed in the shortest possible time, including the early detection of VITT. The coagulation community is already reaping the benefits from these new ways of working and also building the tenacity for any challenge ahead [7].

To learn more about how the coagulation community responded to the pandemic, check out this recent interview with Dr Ng Heng Joo, Head & Senior Consultant in the Department of Haematology at Singapore General Hospital, where he cares for COVID-19 patients.

Resources:
[1] COVID-19 in Journal of Thrombosis and Haemostasis, a timely collection of article relating to the Coronavirus outbreak.

[2] “When COVID-19 calls, an ISTH task force answers”, ISTH 2021

[3] Bell, R. et al. (2020) The hematology laboratory’s response to the COVID-19 pandemic: A scoping review. International Journal of Laboratory Hematology. 43(2), pp148-159.

[4] “The right anticoagulation dose in COVID-19? Final answer remains elusive”, tctMD

[5] World Health Organisation Guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination to prevent coronavirus disease (COVID-19)

[6] “Emergence of VITT: The role of prompt and intensified worldwide research collaboration”, ISTH 2021

[7] ISTH Global Response to COVID-19