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Rotational thromboelastometry in patients with acute respiratory distress syndrome owing to coronavirus disease 2019: Is there a viscoelastic fingerprint and a role for predicting thrombosis?
Vasovic, Ljiljana V; Littlejohn, James; Alqunaibit, Dalia; Dillard, Alicia; Qiu, Yuqing; Rand, Sophie; Bronstein, Matthew; Gibson, Cameron J; Kelly, Anton G; Lee, Christina; Minneman, Jennifer A; Narayan, Mayur; Shou, Jian; Smith, Kira E; Villegas, Cassandra V; Winchell, Robert J; Cushing, Melissa M; Barie, Philip S.
  • Vasovic LV; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY.
  • Littlejohn J; Department of Anesthesiology, Weill Cornell Medicine, New York, NY. Electronic address: jel9088@med.cornell.edu.
  • Alqunaibit D; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Dillard A; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY.
  • Qiu Y; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
  • Rand S; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY.
  • Bronstein M; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Gibson CJ; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Kelly AG; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Lee C; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Minneman JA; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Narayan M; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Shou J; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Smith KE; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Villegas CV; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Winchell RJ; Department of Surgery, Weill Cornell Medicine New York, NY.
  • Cushing MM; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY.
  • Barie PS; Department of Surgery, Weill Cornell Medicine New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY.
Surgery ; 171(4): 1092-1099, 2022 04.
Article in English | MEDLINE | ID: covidwho-1401876
ABSTRACT

OBJECTIVES:

We evaluated rotational thromboelastometry tracings in 44 critically ill coronavirus disease 2019 patients, to determine whether there is a viscoelastic fingerprint and to test the hypothesis that the diagnosis and prediction of venous thromboembolism would be enhanced by the addition of rotational thromboelastometry testing.

RESULTS:

Rotational thromboelastometry values reflected an increase in clot strength for the EXTEM, INTEM, and FIBTEM assays beyond the reference range. No hyperfibrinolysis was noted. Fibrinolysis shutdown was present but did not correlate with thrombosis; 32% (14/44) of patients experienced a thrombotic episode. For every 1 mm increase of FIBTEM maximum clot formation, the odds of developing thrombosis increased 20% (95% confidence interval, 0-40%, P = .043), whereas for every 1,000 ng/mL increase in D-dimer, the odds of thrombosis increased by 70% (95% confidence interval, 20%-150%, P = .004), after adjustment for age and sex (AUC 0.96, 95% confidence interval, 0.90-1.00). There was a slight but significant improvement in model performance after adding FIBTEM maximum clot formation and EXTEM clot formation time to D-dimer in a multivariable model (P = .04).

CONCLUSIONS:

D-dimer concentrations were more predictive of thrombosis in our patient population than any other parameter. Rotational thromboelastometry confirmed the hypercoagulable state of coronavirus disease 2019 intensive care unit patients. FIBTEM maximum clot formation and EXTEM clot formation time increased the predictability for thrombosis compared with only using D-dimer. Rotational thromboelastometry analysis is most useful in augmenting the information provided by the D-dimer concentration for venous thromboembolism risk assessment when the D-dimer concentration is between 1,625 and 6,900 ng/dL, but the enhancement is modest. Fibrinolysis shutdown did not correlate with thrombosis.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Thrombosis / Thrombophilia / COVID-19 Type of study: Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Surgery Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Thrombosis / Thrombophilia / COVID-19 Type of study: Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Surgery Year: 2022 Document Type: Article