TY - JOUR
T1 - Diagnosis and treatment of coagulopathy using thromboelastography with platelet mapping is associated with decreased risk of pulmonary failure in COVID-19 patients
AU - Hranjec, Tjasa
AU - Mayhew, Mackenzie
AU - Rogers, Bradley
AU - Solomon, Rachele
AU - Hurst, Deborah
AU - Estreicher, Michael
AU - Augusten, Alberto
AU - Nunez, Aaron
AU - Green, Melissa
AU - Malhotra, Shivali
AU - Katz, Randy
AU - Rosenthal, Andrew
AU - Hennessy, Sara
AU - Pepe, Paul
AU - Sawyer, Robert
AU - Arenas, Juan
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - IntroductionTreatment of coronavirus disease 2019 (COVID-19) patients may require antithrombotic and/or anti-inflammatory medications. We hypothesized that individualized anticoagulant (AC) management, based on diagnosis of coagulopathy using thromboelastography with platelet mapping (TEG-PM), would decrease the frequency of pulmonary failure (PF) requiring mechanical ventilation (MV), mitigate thrombotic and hemorrhagic events, and, in-turn, reduce mortality.MethodsHospital-admitted COVID-19 patients, age 18 or older, with escalating oxygen requirements were included. Prospective and supplemental retrospective chart reviews were conducted during a 2-month period. Patients were stratified into two groups based on clinician-administered AC treatment: TEG-PM guided vs. non-TEG guided.ResultsHighly-elevated inflammatory markers (D-dimer, C-reactive protein, ferritin) were associated with poor prognosis but did not distinguish coagulopathic from noncoagulopathic patients. TEG-guided AC treatment was used in 145 patients vs. 227 treated without TEG-PM guidance. When managed by TEG-PM, patients had decreased frequency of PF requiring MV (45/145 [31%] vs. 152/227 [66.9%], P < 0.0001), fewer thrombotic events (2[1.4%] vs. 39[17.2%], P = 0.0019) and fewer hemorrhagic events (6[4.1%] vs. 24[10.7%],P = 0.0240), and had markedly reduced mortality (43[29.7%] vs. 142[62.6%], P < 0.0001). Platelet hyperactivity, indicating the need for antiplatelet medications, was identified in 75% of TEG-PM patients. When adjusted for confounders, empiric, indiscriminate AC treatment (not guided by TEG-PM) was shown to be an associated risk factor for PF requiring MV, while TEG-PM guided management was associated with a protective effect (odds ratio = 0.18, 95% confidence interval 0.08-0.4).ConclusionsFollowing COVID-19 diagnosis, AC therapies based on diagnosis of coagulopathy using TEG-PM were associated with significantly less respiratory decompensation, fewer thrombotic and hemorrhagic complications, and improved likelihood of survival.
AB - IntroductionTreatment of coronavirus disease 2019 (COVID-19) patients may require antithrombotic and/or anti-inflammatory medications. We hypothesized that individualized anticoagulant (AC) management, based on diagnosis of coagulopathy using thromboelastography with platelet mapping (TEG-PM), would decrease the frequency of pulmonary failure (PF) requiring mechanical ventilation (MV), mitigate thrombotic and hemorrhagic events, and, in-turn, reduce mortality.MethodsHospital-admitted COVID-19 patients, age 18 or older, with escalating oxygen requirements were included. Prospective and supplemental retrospective chart reviews were conducted during a 2-month period. Patients were stratified into two groups based on clinician-administered AC treatment: TEG-PM guided vs. non-TEG guided.ResultsHighly-elevated inflammatory markers (D-dimer, C-reactive protein, ferritin) were associated with poor prognosis but did not distinguish coagulopathic from noncoagulopathic patients. TEG-guided AC treatment was used in 145 patients vs. 227 treated without TEG-PM guidance. When managed by TEG-PM, patients had decreased frequency of PF requiring MV (45/145 [31%] vs. 152/227 [66.9%], P < 0.0001), fewer thrombotic events (2[1.4%] vs. 39[17.2%], P = 0.0019) and fewer hemorrhagic events (6[4.1%] vs. 24[10.7%],P = 0.0240), and had markedly reduced mortality (43[29.7%] vs. 142[62.6%], P < 0.0001). Platelet hyperactivity, indicating the need for antiplatelet medications, was identified in 75% of TEG-PM patients. When adjusted for confounders, empiric, indiscriminate AC treatment (not guided by TEG-PM) was shown to be an associated risk factor for PF requiring MV, while TEG-PM guided management was associated with a protective effect (odds ratio = 0.18, 95% confidence interval 0.08-0.4).ConclusionsFollowing COVID-19 diagnosis, AC therapies based on diagnosis of coagulopathy using TEG-PM were associated with significantly less respiratory decompensation, fewer thrombotic and hemorrhagic complications, and improved likelihood of survival.
KW - TEG and COVID-19
KW - anticoagulation in COVID-19
KW - coagulopathy of COVID-19
KW - hypercoagulability of COVID-19
KW - individualized treatment of COVID-19
KW - platelet hyperactivity and COVID-19
KW - platelet mapping and COVID-19
UR - http://www.scopus.com/inward/record.url?scp=85176509687&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85176509687&partnerID=8YFLogxK
U2 - 10.1097/MBC.0000000000001259
DO - 10.1097/MBC.0000000000001259
M3 - Article
C2 - 37831624
AN - SCOPUS:85176509687
SN - 0957-5235
VL - 34
SP - 508
EP - 516
JO - Blood Coagulation and Fibrinolysis
JF - Blood Coagulation and Fibrinolysis
IS - 8
ER -