Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Thromboelastography (TEG) in COVID-19 Patients - Not All Hypercoagulable

Session Title
TP50 - TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI
Abstract
A2580 - Thromboelastography (TEG) in COVID-19 Patients - Not All Hypercoagulable
Author Block: I. Yousef1, P. B. Desai2, S. Sehgal3, R. Gupta4, M. Gordon5, M. Weir6, N. Ali7, G. J. Criner8, A. Rao9, P. Rali10; 1Thoracic medicine and surgery, Temple University Hospital, Philadelphia, PA, United States, 2Temple Univ Hosp, Philadelphia, PA, United States, 3Thoracic medicine and surgery, Temple University, philadelphia, PA, United States, 4Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, United States, 5Dept. of Thoracic Medicine and Surgery, Temple Univ. Hospital, Philadelphia, PA, United States, 6Pulmonary & Critical Care, Temple University Hospital, Philadelphia, PA, United States, 7Internal Medicine, section of hematology, Temple University Hospital, Philadelphia, PA, United States, 8Pulm & Crit Care Med, Temple Univ Hosp, Philadelphia, PA, United States, 9Department of Medicine, section of Hematology, Temple University Hospital, Philadelphia, PA, United States, 10Pulmonary and Critical Care Medicine, Temple University, Philadelphia, PA, United States.
Introduction COVID-19 can lead to a severe inflammatory response and cytokine storm, which is associated with activation of blood coagulation, platelets, and endothelium leading to a severe prothrombotic state. Recent studies have interpreted TEG parameters of increased maximum amplitude (MA) and alpha angle (AA) as indicating a hypercoagulable pattern in patients with COVID-19. The definition of hypercoagulability in literature has been variable while some have used increased MA, others used increased coagulation index (CI) as a surrogate for a hypercoagulable state. Here we report our center experience using TEG to evaluate coagulation in COVID-19 patients. Methods Retrospective analysis of 37 critically ill patients that were evaluated using TEG on a single occasion along with standard coagulation tests. We defined hypercoagulable pattern as CI > 3; hypocoagulable pattern was defined as CI < - 3; and normal pattern if CI was between -3-3. Results TEG patterns were interpreted as hypercoagulable in 5 (13.5%), normal in 22 (59.5%) and hypocoagulable in 10 (27%) patients using the TEG coagulation index (CI). MA and AA were elevated in 13 (35.1%) and 10 (27%) patients, respectively, and both were elevated in 8 (21.6%). Discussion Our results show a normal TEG pattern in most of our critically ill COVID-19 patients based on CI (Figure 1); only 5 (13.5%) showed a hypercoagulable pattern. These findings differ from previous reports of TEG in COVID-19 patients, where a hypercoagulable TEG pattern was shown in 83-90% of patients, in these reports interpretation of hypercoagulability was based on AA or MA. We used the CI to define a hypercoagulable state, which has been used to define hypercoagulability in orthopedic surgery and during pregnancy. An elevated MA or AA was seen in only 15 (40%) of our patients. Plasma fibrinogen, an acute-phase reactant, is also elevated in COVID-19 patients. The mean fibrinogen level in our patients was 364 mg/dl, which is lower than those reported by Panigada and Mortus, where mean fibrinogen levels were 680 and 740 mg/dl, respectively. The high MA may reflect the high fibrinogen observed in COVID-19 patients and this may explain the differences in the number of patients considered as “hypercoagulable” in our cohort compared to others. Conclusion; Our study in COVID-19 patients advances a caution in the interpretation of TEG parameters and its use as an indicator of a hypercoagulable state in COVID-19 patients.