Department of Pulmonology and Critical Care, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA.
6886Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
J Intensive Care Med. 2021 Jun;36(6):689-695. doi: 10.1177/0885066621997039. Epub 2021 Mar 1.
D-dimer concentration has been used by institutions to identify candidates for intensified anticoagulant treatment for venous thromboembolism prevention and for the mitigation of the microthrombotic complications associated with COVID-19. Thromboelastography (TEG) maximum amplitude (MA) has been validated as a marker of hypercoagulability and MA ≥68 mm has been utilized as a marker of hypercoagulability in other conditions.
The goal of this study was to evaluate the relationship between coagulation, inflammatory, and TEG parameters in patients with COVID-19 on extracorporeal membrane oxygenation (ECMO). We performed a single-center retrospective analysis of consecutive patients that received ECMO for the treatment of COVID-19. TEG, inflammatory, and coagulation markers were compared in patients with and without a thrombotic complication. Correlation tests were performed to identify the coagulation and inflammatory markers that best predict hypercoagulability as defined by an elevated TEG MA.
A total of 168 TEGs were available in 24 patients. C-reactive protein and fibrinogen were significantly higher in patients that developed a thrombotic event versus those that did not ( = 0.04 and = 0.04 respectively). D-dimer was negatively correlated with TEG MA ( < 0.01), while fibrinogen was positively correlated ( < 0.01). A fibrinogen >441 mg/dL was found to have a sensitivity of 91.2% and specificity of 85.7% for the detection of MA ≥68 mm.
In critically ill patients with COVID-19 treated with ECMO, D-dimer concentration had an inverse relationship with degree of hypercoagulability as measured by TEG MA. D-dimer elevation may potentially reflect hemostatic perturbation in patients on ECMO or the severity of COVID-19 related sepsis rather than designate patients likely to benefit from anticoagulation. Fibrinogen concentration may represent a more useful marker of hypercoagulability in this population.
机构一直使用 D-二聚体浓度来识别静脉血栓栓塞预防和缓解 COVID-19 相关微血栓并发症的强化抗凝治疗候选者。血栓弹力图（TEG）最大振幅（MA）已被验证为高凝状态的标志物，并且在其他情况下，MA≥68mm 已被用作高凝状态的标志物。
本研究的目的是评估 COVID-19 患者体外膜肺氧合（ECMO）治疗中的凝血、炎症和 TEG 参数之间的关系。我们对接受 ECMO 治疗 COVID-19 的连续患者进行了单中心回顾性分析。比较了有血栓并发症和无血栓并发症患者的 TEG、炎症和凝血标志物。进行相关测试以确定最佳预测 TEG MA 升高的高凝状态的凝血和炎症标志物。
在 24 名患者中共有 168 次 TEG 可用。与未发生血栓事件的患者相比，发生血栓事件的患者 C 反应蛋白和纤维蛋白原显著升高（=0.04 和=0.04）。D-二聚体与 TEG MA 呈负相关（<0.01），而纤维蛋白原与 TEG MA 呈正相关（<0.01）。纤维蛋白原>441mg/dL 用于检测 MA≥68mm 的灵敏度为 91.2%，特异性为 85.7%。
在接受 ECMO 治疗的 COVID-19 危重症患者中，D-二聚体浓度与 TEG MA 测量的高凝程度呈反比关系。D-二聚体升高可能潜在反映 ECMO 患者的止血紊乱或 COVID-19 相关脓毒症的严重程度，而不是指定可能受益于抗凝治疗的患者。纤维蛋白原浓度可能是该人群中更有用的高凝状态标志物。
