Thromboelastography Six: Redefining heparin resistance in post COVID syndrome
Recommended Citation
Payne J, Coba V, Marrocco A, Long T, Gupta N, Hodari‐Gupta A, Lopez‐Plaza I. Thromboelastography Six: Redefining heparin resistance in post COVID syndrome. Research and Practice in Thrombosis and Haemostasis 2022; 6(Supplement 1).
Document Type
Conference Proceeding
Publication Date
10-1-2022
Publication Title
Research and Practice in Thrombosis and Haemostasis
Abstract
Background: In the literature there has been minimal discussion of heparin resistance with regards to the post-COVID syndrome. Since the COVID pandemic began, patients with COVID were suffering complications from VTE that suggested the presence of a hypercoagulable state. Generally this hypercoagulable state is described through the use of thromboelastogram six (TEG6) with a short R time, wide alpha angle and a very large amplitude. Aims: In this case we were using the TEG6 as a guide for heparin therapy by following the CK-R time compared to the CKH-R time (with heparinase). We observed no bleeding or clotting events. While the patient was on ECMO, there were no changes in the delta-P and the circuit was not replced during his clinical course. Additionally, he required no blood transfusions during this time. Methods: An observational analysis of TEG6 in COVID-19 ECMO patient while using an anti-Xa heparin based protocol for therapeutic heparin therapy. Results: On the initial TEG6, there was a significantly prolonged R time that was partially corrected with heparinase -with heparin dosing of 24 IU/kg/h (65,000 IU/day), see figure one. With the prolonged R time, heparin was descalated to 16 IU/kg/h and the coagulation profile was resent, see figure two. Additionally, the TEG6 MA remained elevated -consistent with the hypercoagulable post-COVID syndrome. This occurred in the setting of a normal anti-thrombin three level and platelet counts. Conclusion(s): Through the use of TEG6, we were able to better characterize his coagulation profile and we were able to deescalate his dosing of heparin using the CK and CKH-R time comparison. We propose using TEG6 to redefine heparin resistance in the post-COVID syndrome of hypercoagulopathy, as older modalities may not be accurately reflecting this modern pathology. (Figure Presented).
Volume
6
Issue
Supplement 1
