Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization
Background Clinical hypercoagulopathy in patients with COVID-19 has been anecdotally described, but there is lack of evidence due to the novelty of this disease. Our study reports the results of rotational thromboelastography (ROTEM) in relation to traditional laboratory coagulation tests and acute...
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BMJ Publishing Group
2022-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/7/1/e000603.full |
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| author | Peter Rhee Rifat Latifi Abbas Smiley Kartik Prabhakaran Joshua Klein James K Choi Gary Lombardo |
| author_facet | Peter Rhee Rifat Latifi Abbas Smiley Kartik Prabhakaran Joshua Klein James K Choi Gary Lombardo |
| author_sort | Peter Rhee |
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| description | Background Clinical hypercoagulopathy in patients with COVID-19 has been anecdotally described, but there is lack of evidence due to the novelty of this disease. Our study reports the results of rotational thromboelastography (ROTEM) in relation to traditional laboratory coagulation tests and acute phase markers among a cohort of severely ill, mechanically ventilated patients with COVID-19.Methods Patients with COVID-19 (N=21) with respiratory failure requiring mechanical ventilation were included in this prospective case series. ROTEM was serially obtained for all patients on three different days during their intensive care unit (ICU) stay and analyzed using repeated measures analysis. Demographic variables, symptoms at the time of presentation, ROTEM values, laboratory values for traditionally measured coagulation profiles, and acute phase reactants were analyzed, in addition to the use of anticoagulation and clinical hypercoagulopathic complications.Results The average age of our cohort was 57.9 years old (SD=14.4) and 76.2% were male. The mortality rate was 14.3% (3 of 21). Two patients (12.5%) were identified to have new-onset deep vein thrombosis, two patients (12.5%) were found to have ≥3 episodes of central venous catheter thrombosis, and three patients (18.7%) had confirmed stroke. ROTEM demonstrated elevated EXTEM and INTEM clotting times, including elevated FIBTEM maximum clot firmness (MCFFIB). All patients treated with therapeutic anticoagulation still demonstrated hypercoagulopathy within the MCFFIB tests.Discussion Repeated measure ROTEMs were able to detect hypercoagulopathy in ICU patients with COVID-19 despite therapeutic anticoagulation with heparin.Level of evidence III. |
| format | Article |
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| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
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| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-d507eb080fca4e78a352ea2cc30b261c2024-11-30T06:35:11ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762022-10-017110.1136/tsaco-2020-000603Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinizationPeter Rhee0Rifat Latifi1Abbas Smiley2Kartik Prabhakaran3Joshua Klein4James K Choi5Gary Lombardo6Department of Surgery, New York Medical College, Valhalla, New York, USAInternational Virtual eHospital Foundation, Hope, Idaho, USADepartment of Surgery, New York Medical College, Valhalla, New York, USASurgery, Westchester Medical Center Health Network, Valhalla, New York, USASurgery, Westchester Medical Center, Valhalla, New York, USADepartment of Surgery, Westchester Medical Center, Valhalla, New York, USADepartment of Surgery, Westchester Medical Center, Valhalla, New York, USABackground Clinical hypercoagulopathy in patients with COVID-19 has been anecdotally described, but there is lack of evidence due to the novelty of this disease. Our study reports the results of rotational thromboelastography (ROTEM) in relation to traditional laboratory coagulation tests and acute phase markers among a cohort of severely ill, mechanically ventilated patients with COVID-19.Methods Patients with COVID-19 (N=21) with respiratory failure requiring mechanical ventilation were included in this prospective case series. ROTEM was serially obtained for all patients on three different days during their intensive care unit (ICU) stay and analyzed using repeated measures analysis. Demographic variables, symptoms at the time of presentation, ROTEM values, laboratory values for traditionally measured coagulation profiles, and acute phase reactants were analyzed, in addition to the use of anticoagulation and clinical hypercoagulopathic complications.Results The average age of our cohort was 57.9 years old (SD=14.4) and 76.2% were male. The mortality rate was 14.3% (3 of 21). Two patients (12.5%) were identified to have new-onset deep vein thrombosis, two patients (12.5%) were found to have ≥3 episodes of central venous catheter thrombosis, and three patients (18.7%) had confirmed stroke. ROTEM demonstrated elevated EXTEM and INTEM clotting times, including elevated FIBTEM maximum clot firmness (MCFFIB). All patients treated with therapeutic anticoagulation still demonstrated hypercoagulopathy within the MCFFIB tests.Discussion Repeated measure ROTEMs were able to detect hypercoagulopathy in ICU patients with COVID-19 despite therapeutic anticoagulation with heparin.Level of evidence III.https://tsaco.bmj.com/content/7/1/e000603.full |
| spellingShingle | Peter Rhee Rifat Latifi Abbas Smiley Kartik Prabhakaran Joshua Klein James K Choi Gary Lombardo Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization Trauma Surgery & Acute Care Open |
| title | Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization |
| title_full | Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization |
| title_fullStr | Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization |
| title_full_unstemmed | Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization |
| title_short | Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization |
| title_sort | serial rotational thromboelastography rotem in mechanically ventilated patients with covid 19 demonstrates hypercoagulopathy despite therapeutic heparinization |
| url | https://tsaco.bmj.com/content/7/1/e000603.full |
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