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2021, Number 6

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Med Crit 2021; 35 (6)

Thromboelastographic profile in patients with SARS-CoV-2 pneumonia

Salvador IIJ, Alva ANV, Ramírez REF, Pizaña DA, Huerta EMG, Gasca AJC

Language: Spanish
References: 27
Page: 312-318
PDF size: 344.10 Kb.


ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The risk of venous thrombotic events (VTE), which is increased in critically ill patients, is likely to be even higher in those with SARS-CoV-2 and critical illness. Objectives: To investigate the haemostatic profile by TEG in patients with COVID-19 pneumonia. Material and methods: Observational, retrospective study of a single hospital centre. Patients hospitalised with a diagnosis of COVID-19 pneumonia were retrospectively enrolled and underwent thromboelastogram (TEG) at 24 and 72 hours. Bivariate analysis was performed, in which Student's t-tests or Mann-Whitney U-tests were used for continuous and discrete quantitative variables. For categorical and nominal variables, Pearson's χ2 test was used. In addition, a receiver operating characteristic (ROC) curve was performed to determine the body mass index (BMI) cut-off point with the highest sensitivity and specificity in relation to the development of TEG alterations. Subsequently, a multivariate logistic binary regression analysis was performed, adjusted for variables with clinical and statistical significance. Statistical significance was established as a p < 0.05 or < 5%. Results: A total of 66 patients were included, a predominance of hypercoagulable profile was observed in 28 patients (42.4%) at 24 hours and 20 (30.3%) at 72 hours despite prophylactic doses of enoxaparin. To determine the cut-off point with the strongest association between BMI and the presence of TEG disorder, a ROC curve was performed, yielding an ABC of 64.7% (p = 0.003). We found an odds ratio (OR) of 1.8 for each kilogram of weight above a BMI > 26.2 kg/m2, for developing hypercoagulability. Conclusion: The high percentage of patients with hypercoagulable status and hyperfibrinogenemia could lead to an increase in fibrin formation and polymerisation that may predispose to thrombosis. The majority of the population in our setting is overweight or obese and therefore probably requires a higher anticoagulation regimen. Such a thromboprophylaxis scheme should not be guided by parameters such as dimer D but by a broader haemostatic profile test such as TEG.


REFERENCES

  1. Walls AC, Park YJ, Tortorici MA, et al. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020;181(2):281-292.e6. doi: 10.1016/j.cell.2020.02.058.

  2. Worldometer. COVID-19 coronavirus pandemic [internet]. 2021 [Consultado 5 Ago 2021]. Disponible en: https://www.worldometers.info/coronavirus/

  3. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi: 10.1001/jama.2020.2648.

  4. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta. 2020;506:145-148. doi: 10.1016/j.cca.2020.03.022.

  5. Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost. 2020;120(5):876-878. doi: 10.1016/j.cca.2020.03.022.

  6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3.

  7. Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-796. doi: 10.1002/jmv.25770.

  8. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943. doi: 10.1001/jamainternmed.2020.0994.

  9. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23):2950-2973. doi: 10.1016/j.jacc.2020.04.031.

  10. Salem N, Atallah B, El Nekidy WS, Sadik ZG, Park WM, Mallat J. Thromboelastography findings in critically ill COVID-19 patients. J Thromb Thrombolysis. 2021;51(4):961-965. doi: 10.1007/s11239-020-02300-7.

  11. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18(7):1559-1561. doi: 10.1111/jth.14849.

  12. Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020;18(7):1747-1751. doi: 10.1111/jth.14854.

  13. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-847. doi: 10.1111/jth.14768.

  14. Al-Samkari H. Finding the optimal thromboprophylaxis dose in patients with COVID-19. JAMA. 2021;325(16):1613-1615. doi: 10.1001/jama.2021.4295.

  15. Kruse JM, Magomedov A, Kurreck A, et al. Thromboembolic complications in critically ill COVID-19 patients are associated with impaired fibrinolysis. Crit Care. 2020;24(1):676. doi: 10.1186/s13054-020-03401-8.

  16. Spiezia L, Boscolo A, Poletto F, et al. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost. 2020;120(6):998-1000.

  17. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7.

  18. Panigada M, Bottino N, Tagliabue P, et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020;18(7):1738-1742. doi: 10.1111/jth.14850.

  19. Pavoni V, Gianesello L, Pazzi M, Stera C, Meconi T, Frigieri FC. Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. J Thromb Thrombolysis. 2020;50(2):281-286. doi: 10.1007/s11239-020-02130-7.

  20. REMAP-CAP Investigators; ACTIV-4a Investigators; ATTACC Investigators, Goligher EC, Bradbury CA, McVerry BJ, et al. Therapeutic anticoagulation with heparin in critically ill patients with Covid-19. N Engl J Med. 2021;385(9):777-789. doi: 10.1056/NEJMoa2103417.

  21. Rokkam VRP, Vegunta R, Prudhvi K, et al. "Weighing" the risks and benefits-Thromboprophylaxis challenges in obese COVID-19 patients. Obes Med. 2020;19:100284. doi: 10.1016/j.obmed.2020.100284.

  22. Zufferey PJ, Dupont A, Lanoiselée J, et al. Pharmacokinetics of enoxaparin in COVID-19 critically ill patients. Thromb Res. 2021;205:120-127. doi: 10.1016/j.thromres.2021.07.010.

  23. INSPIRATION Investigators, Sadeghipour P, Talasaz AH, Rashidi F, et al. Effect of intermediate-dose vs standard-dose prophylactic anticoagulation on thrombotic events, extracorporeal membrane oxygenation treatment, or mortality among patients with COVID-19 admitted to the intensive care unit: The INSPIRATION randomized clinical trial. JAMA. 2021;325(16):1620-1630. doi: 10.1001/jama.2021.4152.

  24. Lim W, Meade M, Lauzier F, et al. Failure of anticoagulant thromboprophylaxis: risk factors in medical-surgical critically ill patients1. Crit Care Med. 2015;43(2):401-410. doi: 10.1097/CCM.0000000000000713.

  25. Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med. 2020;173(4):268-277. doi: 10.7326/M20-2003.

  26. Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46(6):1089-1098. doi: 10.1007/s00134-020-06062-x.

  27. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-147. doi: 10.1016/j.thromres.2020.04.013.




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