Combination analysis of coagulation markers and thromboelastography in COVID-19 ECMO recipients

Background: D dimer is suggested as a marker of hypercoagulability in COVID patients and identify those for anticoagulation therapy Methods: A single center analysis of 24 consecutive COVID ECMO patients who had simultaneous coagulation, inflammatory markers, and TEG 5000™ drawn Values were compared in patients with and without a thrombotic complication during admission Results: Pt characteristics: All Subjects Macrothrombosis No thrombosis P Value n=24 n=12 n=12 MA (mm) 72 8 (71 2,78 4) 74 9 (72 3, 79 9) 72 1 (70 6, 77 9) 0 225 R time (min) 10 4 (8 5,12 8) 11 6 (8 6, 12 5) 10 3 (8 4, 13 1) 0 864 D-dimer (ug/mL) 3 5 (2 4,7 9) 3 1 (2 4, 4 6) 3 9 (2 5, 9 0) 0 312 Fibrinogen (mg/dL) 543 5 (476 5, 674 6) 582 5 (538 4, 758 4) 501 5 (447 5, 575 9) 0 043 CRP (mg/dL) 11 1 (4 8, 17 8) 15 3 (8 4, 26 9) 7 55 (3 2, 12 3) 0 038 Ferritin (ng/mL) 985 2 (631 0, 2047 9) 1004 6 (577 8, 2258 3) 965 8 (730 7, 1785 0) 0 922 Bleeding complication 2 (8 3%) 2 (8 3%) 0 (0 0%) 0 478 TEG MA level >68 has been associated with hypercoagulable state Of168 TEGs (46 heparin, 122 bivalirudin) analyzed, D-dimer was negatively correlated with TEG MA and explained little of the variance in this variable (adjusted R =0 162) Fibrinogen was significantly positively correlated (p441 mg/dL had high diagnostic accuracy (sensitivity 91 2%, specificity 85 7%) for the detection of MA ≥ 68 mm Conclusion: D dimer may not be adequate to identify hypercoagulable patients for anticoagulation therapy Fibrinogen and/or viscoelastic testing may prove more accurate Further work is required in this unique patient population