Article ; Online: Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019-Related Coagulopathy.
Critical care explorations
2020 Volume 2, Issue 12, Page(s) e0287
Abstract: ... characterizes the spectrum of coronavirus disease 2019 coagulation-related abnormalities and may guide more ... coronavirus disease 2019-relatedcoagulopathic state and, secondarily, improve outcomes.: Design setting and ... patients: Coronavirus disease 2019 patients (: Interventions: Standard-of-care therapy with or ...
| Abstract | Objectives: Coagulopathy of coronavirus disease 2019 is largely described as hypercoagulability, yet both thrombotic and hemorrhagic complications occur. Although therapeutic and prophylactic anticoagulant interventions have been recommended, empiric use of antifactor medications (heparin/enoxaparin) may result in hemorrhagic complications, including death. Furthermore, traditional (antifactor) anticoagulation does not address the impact of overactive platelets in coronavirus disease 2019. The primary aim was to evaluate if algorithm-guided thromboelastography with platelet mapping could better characterize an individual's coronavirus disease 2019-relatedcoagulopathic state and, secondarily, improve outcomes. Design setting and patients: Coronavirus disease 2019 patients ( Interventions: Standard-of-care therapy with or without algorithm-guided-thromboelastography support. Measurements and main results: Although d-dimer, C-reactive protein, and ferritin were elevated significantly in critically ill (nonsurvivors, acute kidney injury, pulmonary failure), they did not distinguish between coagulopathic and noncoagulopathic patients. Platelet hyperactivity (maximum amplitude-arachidonic acid/adenosine diphosphate > 50 min), with or without thrombocytosis, was associated with thrombotic/ischemic complications, whereas severe thrombocytopenia (platelet count < 100,000/μL) was uniformly fatal. Hemorrhagic complications were observed with decreased factor activity (reaction time > 8 min). Non-algorithm-guided patients had increased risk for subsequent mechanical ventilation (relative risk = 10.9; Conclusions: Thromboelastography with platelet mapping better characterizes the spectrum of coronavirus disease 2019 coagulation-related abnormalities and may guide more tailored, patient-specific therapies in those infected with coronavirus disease 2019. |
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| Language | English |
| Publishing date | 2020-12-21 |
| Publishing country | United States |
| Document type | Journal Article |
| ISSN | 2639-8028 |
| ISSN (online) | 2639-8028 |
| DOI | 10.1097/CCE.0000000000000287 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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