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Thromboelastography Profiles of Critically Ill Patients With Coronavirus Disease 2019.
Yuriditsky, Eugene; Horowitz, James M; Merchan, Cristian; Ahuja, Tania; Brosnahan, Shari B; McVoy, Lauren; Berger, Jeffrey S.
  • Yuriditsky E; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY.
  • Horowitz JM; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY.
  • Merchan C; Department of Pharmacy, NYU Langone Health, New York, NY.
  • Ahuja T; Department of Pharmacy, NYU Langone Health, New York, NY.
  • Brosnahan SB; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Langone Health, New York, NY.
  • McVoy L; Department of Pathology, NYU Langone Health, New York, NY.
  • Berger JS; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY.
Crit Care Med ; 48(9): 1319-1326, 2020 09.
Article in English | MEDLINE | ID: covidwho-632425
ABSTRACT

OBJECTIVES:

The rate of thromboembolic events among patients with coronavirus disease 2019 is high; however, there is no robust method to identify those at greatest risk. We reviewed thromboelastography studies in critically ill patients with coronavirus disease 2019 to characterize their coagulation states.

DESIGN:

Retrospective.

SETTING:

Tertiary ICU in New York City. PATIENTS Sixty-four patients with coronavirus disease 2019 admitted to the ICU with thromboelastography performed.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

Fifty percent of patients had a clotting index in the hypercoagulable range (clotting index > 3) (median 3.05). Reaction time and K values were below the lower limit of normal in 43.8% of the population consistent with a hypercoagulable profile. The median α angle and maximum amplitude (75.8° and 72.8 mm, respectively) were in the hypercoagulable range. The α angle was above reference range in 70.3% of patients indicative of rapid clot formation. Maximum amplitude, a factor of fibrinogen and platelet count and function, and a measure of clot strength was above reference range in 60.1% of patients. Thirty-one percent had thromboembolic events; thromboelastography parameters did not correlate with events in our cohort. Those with D-dimer values greater than 2,000 were more likely to have shorter reaction times compared with those with D-dimer levels less than or equal to 2,000 (4.8 vs 5.6 min; p = 0.001).

CONCLUSIONS:

A large proportion of critically ill patients with coronavirus disease 2019 have hypercoagulable thromboelastography profiles with additional derangements related to fibrinogen and platelet function. As the majority of patients have an elevated thromboelastography maximum amplitude, a follow-up study evaluating platelet aggregation would be instructive.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Thrombelastography / Coronavirus Infections / Thrombophilia / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Med Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Thrombelastography / Coronavirus Infections / Thrombophilia / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Med Year: 2020 Document Type: Article