Utilization of Thromboelastogram and Inflammatory Markers in the Management of Hypercoagulable State in Patients with COVID-19 Requiring ECMO Support
Autor: | Paul McCarthy, Ankit Sakhuja, Angela Smolarz, Aaron D. Shmookler, Awori J. Hayanga, Vinay Badhwar |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Coronavirus disease 2019 (COVID-19)
medicine.diagnostic_test business.industry RC86-88.9 medicine.medical_treatment Case Report 030208 emergency & critical care medicine Medical emergencies. Critical care. Intensive care. First aid 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Fibrinogen medicine.disease Thrombosis Extracorporeal Thromboelastography 03 medical and health sciences Venous thrombosis 0302 clinical medicine Anesthesia medicine Coagulopathy Extracorporeal membrane oxygenation business medicine.drug |
Zdroj: | Case Reports in Critical Care, Vol 2021 (2021) Case Reports in Critical Care |
ISSN: | 2090-6439 2090-6420 |
Popis: | The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill patients with COVID-19 is evolving. Extracorporeal support independently confers an increased predilection for thrombosis, which can be exacerbated by COVID-19-associated coagulopathy. We present the successful management of a hypercoagulable state in two patients who required venovenous ECMO for the treatment of COVID-19. This included monitoring inflammatory markers (D-dimer and fibrinogen), performing a series of therapeutic plasma exchange procedures, and administering high-intensity anticoagulation therapy and thromboelastography- (TEG-) guided antiplatelet therapy. TPE was performed to achieve goal D-dimer less than 3000 ng/mL D-dimer units ( N ≤ 232 ng / mL D-dimer units) and goal fibrinogen less than 600 mg/dL ( N = 200 -400 mg/dL). These therapies resulted in improved TEG parameters and normalized inflammatory markers. Patients were decannulated after 37 days and 21 days, respectively. Post-ECMO duplex ultrasound of the upper and lower extremities and cannulation sites revealed a nonsignificant deep venous thrombosis at the site of femoral cannulation in patient 2 and no deep venous thrombosis in patient 1. The results of this case report show successful management of a hypercoagulable state among COVID-19 patients requiring ECMO support by utilization of inflammatory markers and TEG. |
Databáze: | OpenAIRE |
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