tetano
Editor, Senior Moderator
Pharmacotherapy
. 2023 May 18.
doi: 10.1002/phar.2829. Online ahead of print. Correlation between Heparin Anti-Xa Activity and Thromboelastography in Adult Critically Ill COVID-19 Patients
Mitchell S Buckley[SUP] 1 [/SUP], Grace E Benanti[SUP] 2 [/SUP], Brian Gilbert[SUP] 3 [/SUP], Jordan Meckel[SUP] 2 [/SUP], Amy L Dzierba[SUP] 4 [/SUP], Robert MacLaren[SUP] 5 [/SUP]
Affiliations
Background: Severe coronavirus disease 2019 (COVID-19) increases the risk of thrombotic complications with unfractionated heparin (UFH) as a commonly used agent in managing venous thromboembolism (VTE). The optimal anticoagulation intensity and monitoring parameters in intensive care unit (ICU )COVID-19 patients remains controversial. The primary study aim was to evaluate the relationship between anti-Xa and thromboelastography (TEG) reaction (R) time in patients with severe COVID-19 receiving therapeutic UFH infusions.
Methods: This was a single-center, retrospective study conducted over a 15-month period (2020-2021). Adult patients with severe COVID-19 administered therapeutic UFH infusions with one or more corresponding TEG and anti-Xa assessments drawn within ≤2 hours of each other were included. The primary end point was the correlation between anti-Xa and TEG R time. Secondary aims were to describe the correlation between activated partial thromboplastin time (aPTT) and TEG R time as well as clinical outcomes. Pearson's coefficient was used to evaluate the correlation using a kappa measure of agreement.
Results: A total of 237 patients consisting of 413 assessments were included. TEG R time very weakly correlated with anti-Xa activity (r[SUP]2[/SUP] =0.032; p<0.0001) and aPTT (r[SUP]2[/SUP] =0.007; p=0.061). Overall, 182 (44.1%) TEG R time and anti-Xa values showed agreement in terms of both demonstrating therapeutic, subtherapeutic, or supratherapeutic anticoagulation. Twenty-eight patients (11.8%) and 21 patients (8.9%) developed a clinically relevant bleed or thromboembolic event, respectively. No significant differences in coagulation and TEG parameters were found between patients with or without bleeding.
Conclusions: A low correlation was found between the TEG R time and anti-Xa activity, while no relationship existed between TEG R time and aPTT during therapeutic UFH anticoagulation in critically ill COVID-19 patients. The role of TEG to routinely monitor and guide UFH anticoagulation dosing remains inconclusive. Further research is necessary to address the laboratory tests needed to help with decision-making on anticoagulation dosing in patients with severe COVID-19.
Keywords: COVID-19; TEG; anticoagulation; critical care; heparin; intensive care unit; thromboelastography.
. 2023 May 18.
doi: 10.1002/phar.2829. Online ahead of print. Correlation between Heparin Anti-Xa Activity and Thromboelastography in Adult Critically Ill COVID-19 Patients
Mitchell S Buckley[SUP] 1 [/SUP], Grace E Benanti[SUP] 2 [/SUP], Brian Gilbert[SUP] 3 [/SUP], Jordan Meckel[SUP] 2 [/SUP], Amy L Dzierba[SUP] 4 [/SUP], Robert MacLaren[SUP] 5 [/SUP]
Affiliations
- PMID: 37199139
- DOI: 10.1002/phar.2829
Background: Severe coronavirus disease 2019 (COVID-19) increases the risk of thrombotic complications with unfractionated heparin (UFH) as a commonly used agent in managing venous thromboembolism (VTE). The optimal anticoagulation intensity and monitoring parameters in intensive care unit (ICU )COVID-19 patients remains controversial. The primary study aim was to evaluate the relationship between anti-Xa and thromboelastography (TEG) reaction (R) time in patients with severe COVID-19 receiving therapeutic UFH infusions.
Methods: This was a single-center, retrospective study conducted over a 15-month period (2020-2021). Adult patients with severe COVID-19 administered therapeutic UFH infusions with one or more corresponding TEG and anti-Xa assessments drawn within ≤2 hours of each other were included. The primary end point was the correlation between anti-Xa and TEG R time. Secondary aims were to describe the correlation between activated partial thromboplastin time (aPTT) and TEG R time as well as clinical outcomes. Pearson's coefficient was used to evaluate the correlation using a kappa measure of agreement.
Results: A total of 237 patients consisting of 413 assessments were included. TEG R time very weakly correlated with anti-Xa activity (r[SUP]2[/SUP] =0.032; p<0.0001) and aPTT (r[SUP]2[/SUP] =0.007; p=0.061). Overall, 182 (44.1%) TEG R time and anti-Xa values showed agreement in terms of both demonstrating therapeutic, subtherapeutic, or supratherapeutic anticoagulation. Twenty-eight patients (11.8%) and 21 patients (8.9%) developed a clinically relevant bleed or thromboembolic event, respectively. No significant differences in coagulation and TEG parameters were found between patients with or without bleeding.
Conclusions: A low correlation was found between the TEG R time and anti-Xa activity, while no relationship existed between TEG R time and aPTT during therapeutic UFH anticoagulation in critically ill COVID-19 patients. The role of TEG to routinely monitor and guide UFH anticoagulation dosing remains inconclusive. Further research is necessary to address the laboratory tests needed to help with decision-making on anticoagulation dosing in patients with severe COVID-19.
Keywords: COVID-19; TEG; anticoagulation; critical care; heparin; intensive care unit; thromboelastography.