A Case Series of Thromboelastography-Guided Anticoagulation in COVID-19 Patients with Inherited and Acquired Hypercoagulable States.

IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Case Reports in Medicine Pub Date : 2021-07-31 eCollection Date: 2021-01-01 DOI:10.1155/2021/5568982
Anthony V Thomas, Kevin P Lin, John E Stillson, Connor M Bunch, Jacob Speybroeck, Grant Wiarda, Hamid Al-Fadhl, Laura Gillespie, Mahmud Zamlut, Daniel H Fulkerson, Rashid Z Khan, Hau C Kwaan, Mark M Walsh
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引用次数: 4

Abstract

One of the complications of the novel coronavirus disease 2019 (COVID-19) is hypercoagulability. For this reason, patients presenting with COVID-19 are often put on therapeutic or intermediate anticoagulation upon hospitalization. A common issue of this anticoagulation is the progression to hypocoagulability resulting in hemorrhage. Therefore, monitoring the hemostatic integrity of critically ill COVID-19 patients is of utmost importance. In this case series, we present the cases of three coagulopathic COVID-19 patients whose anticoagulation was guided by thromboelastography (TEG). In each case, TEG permitted the clinical team to simultaneously prevent thrombotic and hemorrhagic events, a difficult task for COVID-19 patients admitted to the intensive care unit. The first two cases illustrate the utility of TEG to guide anticoagulant dosing for COVID-19 patients when the activated partial thromboplastin time (aPTT) is inaccurate. The first case was a severely ill COVID-19 patient with end-stage renal disease and a falsely elevated aPTT secondary to hypertriglyceridemia. The second case was a severely ill COVID-19 patient with chronic pulmonary disease who demonstrated a falsely elevated aPTT due to polycythemia and hemoconcentration. In both cases, TEG was sensitive to the hypercoagulability caused by the metabolic derangements which enabled the goal-directed titration of anticoagulants. The last case depicts a severely ill COVID-19 patient with an inherited factor V Leiden mutation who required abnormally high dosing to achieve therapeutic anticoagulation, guided by TEG. Hypercoagulopathic COVID-19 patients are difficult to anticoagulate without development of hypocoagulopathy. Treatment of these patients demands goal-directed therapy by diligent laboratory monitoring. This can be accomplished by the use of TEG coupled with aPTT to guide anticoagulation. This case series illustrates the necessity for active hemostatic monitoring of critically ill COVID-19 patients.

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血栓弹性成像引导的COVID-19遗传和获得性高凝状态患者抗凝治疗病例系列
新型冠状病毒病2019 (COVID-19)的并发症之一是高凝血症。因此,出现COVID-19的患者在住院时经常使用治疗性或中间抗凝剂。这种抗凝治疗的一个常见问题是发展为低凝性导致出血。因此,监测COVID-19危重症患者的止血完整性至关重要。在本病例系列中,我们报告了三例凝血功能障碍的COVID-19患者,其抗凝治疗由血栓弹性成像(TEG)指导。在每个病例中,TEG都允许临床团队同时预防血栓和出血事件,这对于入住重症监护室的COVID-19患者来说是一项艰巨的任务。前两个病例说明了TEG在活化部分凝血活素时间(aPTT)不准确时指导COVID-19患者抗凝剂量的效用。第一例为重症COVID-19患者,终末期肾病,继发于高甘油三酯血症的aPTT错误升高。第二例为重症COVID-19合并慢性肺部疾病患者,由于红细胞增多症和血液浓度升高,aPTT错误升高。在这两种情况下,TEG对代谢紊乱引起的高凝性很敏感,这使得抗凝剂的目标定向滴定成为可能。最后一个病例描述了一名患有遗传因子V Leiden突变的重症COVID-19患者,在TEG的指导下,需要异常高剂量才能实现治疗性抗凝。高凝病COVID-19患者在不发生低凝病的情况下很难抗凝。这些患者的治疗需要通过勤奋的实验室监测进行目标导向的治疗。这可以通过使用TEG联合aPTT来指导抗凝来实现。本病例系列说明了对COVID-19危重患者进行主动止血监测的必要性。
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来源期刊
Case Reports in Medicine
Case Reports in Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
1.70
自引率
0.00%
发文量
53
审稿时长
13 weeks
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