Diagnosis and treatment of coagulopathy using thromboelastography with platelet mapping is associated with decreased risk of pulmonary failure in COVID-19 patients.

IF 1.2 4区 医学 Q4 HEMATOLOGY
Blood Coagulation & Fibrinolysis Pub Date : 2023-12-01 Epub Date: 2023-10-03 DOI:10.1097/MBC.0000000000001259
Tjasa Hranjec, Mackenzie Mayhew, Bradley Rogers, Rachele Solomon, Deborah Hurst, Michael Estreicher, Alberto Augusten, Aaron Nunez, Melissa Green, Shivali Malhotra, Randy Katz, Andrew Rosenthal, Sara Hennessy, Paul Pepe, Robert Sawyer, Juan Arenas
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引用次数: 0

Abstract

Introduction: Treatment 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.

Methods: Hospital-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.

Results: Highly-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).

Conclusions: Following 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.

在新冠肺炎患者中,使用血栓弹性成像和血小板标测诊断和治疗凝血障碍与降低肺衰竭风险相关。
简介:2019冠状病毒病(新冠肺炎)患者的治疗可能需要抗血栓和/或抗炎药物。我们假设,基于血栓弹性成像和血小板标测(TEG-PM)对凝血障碍的诊断,个体化抗凝(AC)治疗将降低需要机械通气(MV)的肺功能衰竭(PF)的频率,减轻血栓和出血事件,进而降低死亡率。方法:纳入住院新冠肺炎患者,年龄在18岁或18岁以上,氧气需求增加。在两个月的时间里进行了前瞻性和补充性回顾性图表审查。根据临床医生给予的AC治疗,将患者分为两组:TEG-PM指导组与非TEG指导组。结果:炎症标志物(D-二聚体、C-反应蛋白、铁蛋白)高度升高与预后不良有关,但不能区分凝血病和非凝血病患者。在145名患者中使用了TEG指导的AC治疗,而在没有TEG-PM指导的情况下使用的患者为227名。当使用TEG-PM治疗时,患者需要MV的PF频率降低(45/145[31%]对152/227[66.9%],P 结论:在诊断为新冠肺炎后,基于TEG-PM诊断凝血障碍的AC治疗显著减少了呼吸失代偿,减少了血栓和出血并发症,并提高了生存的可能性。
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来源期刊
CiteScore
1.90
自引率
0.00%
发文量
111
审稿时长
4-8 weeks
期刊介绍: Blood Coagulation & Fibrinolysis is an international fully refereed journal that features review and original research articles on all clinical, laboratory and experimental aspects of haemostasis and thrombosis. The journal is devoted to publishing significant developments worldwide in the field of blood coagulation, fibrinolysis, thrombosis, platelets and the kininogen-kinin system, as well as dealing with those aspects of blood rheology relevant to haemostasis and the effects of drugs on haemostatic components
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