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

Autor: Hranjec T; Department of Surgery, Bronson Methodist Hospital.; Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan.; Department of Surgery, Memorial Regional Hospital, Hollywood., Mayhew M; Florida International University, Miami, Florida.; University of Virginia, Charlottesville, Virginia., Rogers B; Pharmacy Department., Solomon R; Department of Surgery, Memorial Regional Hospital, Hollywood., Hurst D; Department of Emergency Medicine., Estreicher M; University of Virginia, Charlottesville, Virginia., Augusten A; Pharmacy Department., Nunez A; Department of Medicine, Memorial Regional Hospital, Hollywood, Florida., Green M; Department of Medicine, Memorial Regional Hospital, Hollywood, Florida., Malhotra S; Department of Medicine, Memorial Regional Hospital, Hollywood, Florida., Katz R; Department of Emergency Medicine., Rosenthal A; Department of Surgery, Memorial Regional Hospital, Hollywood., Hennessy S; Department of Surgery, University of Texas Southwestern Medical Center., Pepe P; Metropolitan Emergency Medical Services, Medical Directors Coalition Global Hdqtrs, Dallas, Texas, USA., Sawyer R; Department of Surgery, Bronson Methodist Hospital.; Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan., Arenas J; Department of Surgery, Memorial Regional Hospital, Hollywood.
Jazyk: angličtina
Zdroj: Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis [Blood Coagul Fibrinolysis] 2023 Dec 01; Vol. 34 (8), pp. 508-516. Date of Electronic Publication: 2023 Oct 03.
DOI: 10.1097/MBC.0000000000001259
Abstrakt: 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.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze: MEDLINE
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