Anticoagulant therapy monitoring in COVID-19 patients in the intensive care unit: thromboelastometry and echocardiography

ABSTRACT

Aim. To determine the effectiveness of thromboelastometry (TEM) and echocar-diography for anticoagulant therapy monitoring in patients with COVID-19. Material and methods. We analyzed treatment regimen of 92 patients with COVID-19. The patients were divided into two groups. In the control group (n=30), anticoagulant therapy with unfractionated heparin (UFH) was carried out under laboratory control of coagulation parameters. In the experimental group (n=62), anticoagulation was maintained by intravenous UFH under control of coagulation, echocardiography (Philips, Epiq 5) and TEM (ROTEM® delta). Echocardiography determined the pulmonary artery acceleration time (AT), mid-systolic notching (SN). The TEM method was used to study external (EXTEM) and internal (INTEM) pathways, differential tests (FIBTEM, HEPTEM) of coagulation. Statistical analysis was performed by calculating non-parametric statistics parameters, comparisons of differences in groups (Mann-Whitney test), area under the curve (AUC), and regression equations. Results. A high correlation level between echocardiographic and TEM parameters was determined. Their levels associated with a positive prognosis were calculated (AT>113,5 ms., AUC 0,979;p<0,0001;no SN, AUC 0,931;p<0,0001;FIBTEM ML (60 min) >1,12%, AUC 0,971, p<0,0001;INTEM ML (60 min) >2,01%, AUC 0,941, p<0,0001, EXTEM ML (60 min) >1,4%, AUC 0,934, p<0,0001;MCFfib not >26 mm, AUC 0,954;p<0,0001;MCFin not >56,6 mm, AUC 0,938;p<0,0001;MCFex not >47,9 mm, AUC 0,838, p<0,0001). In 33,9% of patients in the experimental group, heparin resistance was detected. In this connection, combined therapy with UFH and direct oral anticoagulants (DOACs) was used, followed by the switch to DOACs. In the control group, artificial ventilation was used in 50% of patients, mortality — 36,6%, myocardial infarction — 13,3%, deep vein thrombosis — 6,6%, pulmonary embolism — 6,6%, while in the experimental group, mechanical ventilation — 12,9%, myocardial infarction — 4,8%, mortality — 8,1%. Conclusion. The dynamic assessment of echocardiography and TEM parameters made it possible to monitor pulmonary thrombosis processes, significantly reduce complications, the use of artificial ventilation and mortality in COVID-19 patients.