Assuntos
Anticoagulantes , Aspirina , Biomarcadores Farmacológicos/sangue , Tratamento Farmacológico da COVID-19 , COVID-19 , Heparina , Testes Imediatos/estatística & dados numéricos , Tromboelastografia/métodos , Negro ou Afro-Americano/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Anticoagulantes/farmacocinética , Aspirina/administração & dosagem , Aspirina/farmacocinética , Disponibilidade Biológica , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/fisiopatologia , Feminino , Hemostasia/efeitos dos fármacos , Hemostasia/fisiologia , Heparina/administração & dosagem , Heparina/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/farmacocinética , Testes de Função Plaquetária/métodos , Testes de Função Plaquetária/estatística & dados numéricos , SARS-CoV-2 , Estados Unidos/epidemiologiaAssuntos
Fibrilação Atrial/tratamento farmacológico , Tamponamento Cardíaco/induzido quimicamente , Inibidores do Fator Xa/efeitos adversos , Falência Renal Crônica/complicações , Rivaroxabana/efeitos adversos , Idoso , Fibrilação Atrial/complicações , Inibidores do Fator Xa/uso terapêutico , Hemorragia/induzido quimicamente , Humanos , Masculino , Rivaroxabana/uso terapêuticoRESUMO
Standard biomarkers have been widely used for COVID-19 diagnosis and prognosis. We hypothesize that thrombogenicity metrics measured by thromboelastography will provide better diagnostic and prognostic utility versus standard biomarkers in COVID-19 positive patients. In this observational prospective study, we included 119 hospitalized COVID-19 positive patients and 15 COVID-19 negative patients. On admission, we measured standard biomarkers and thrombogenicity using a novel thromboelastography assay (TEG-6s). In-hospital all-cause death and thrombotic occurrences (thromboembolism, myocardial infarction and stroke) were recorded. Most COVID-19 patients were African--Americans (68%). COVID-19 patients versus COVID-19 negative patients had higher platelet-fibrin clot strength (P-FCS), fibrin clot strength (FCS) and functional fibrinogen level (FLEV) (Pâ≤â0.003 for all). The presence of high TEG-6âs metrics better discriminated COVID-19 positive from negative patients. COVID-19 positive patients with sequential organ failure assessment (SOFA) score at least 3 had higher P-FCS, FCS and FLEV than patients with scores less than 3 (Pâ≤â0.001 for all comparisons). By multivariate analysis, the in-hospital composite endpoint occurrence of death and thrombotic events was independently associated with SOFA score more than 3 [odds ratio (OR)â=â2.9, Pâ=â0.03], diabetes (ORâ=â3.3, Pâ=â0.02) and FCSâ>â40âmm (ORâ=â3.4, Pâ=â0.02). This largest observational study suggested the early diagnostic and prognostic utility of thromboelastography to identify COVID-19 and should be considered hypothesis generating. Our results also support the recent FDA guidance regarding the importance of measurement of whole blood viscoelastic properties in COVID-19 patients. Our findings are consistent with the observation of higher hospitalization rates and poorer outcomes for African--Americans with COVID-19.