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Infectious Diseases

Thromboelastographic Results and Hypercoagulability Syndrome in Patients With Coronavirus Disease 2019 Who Are Critically Ill

Educational Objective
To understand the associated between Thromboelastographic Results and Hypercoagulability Syndrome in Critically Ill Patients With Coronavirus Disease 2019

1 Credit CME

JAMA Network Open

Published Online: June 5, 2020

Research Letter

Article Information and Disclosures

Jared Robert Mortus, MD¹;

Stephen E. Manek, MD¹;

Lisa Suzanne Brubaker, MD^1,2;

Michele Loor, MD¹;

Miguel Angel Cruz, PhD^2,3;

Barbara W. Trautner, MD, PhD^4,5;

Todd K. Rosengart, MD¹

Author Affiliations

¹Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
²Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, Texas
³Department of Medicine, Baylor College of Medicine, Houston, Texas
⁴Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
⁵Section of Health Services Research, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas

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Severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has caused approximately 300 000 deaths globally. Disseminated intravascular coagulopathy and other COVID-19–associated coagulopathies occur among patients with severe SARS-CoV-2 infections.¹ Potentially lethal hypercoagulability is an unusual, poorly defined COVID-19–associated coagulopathy presentation.²^,3 We found that more than half of patients admitted to the intensive care unit (ICU) of Baylor St Luke’s Medical Center developed clinically significant thromboses that were associated with hypercoagulable thromboelastographic (TEG) parameters alone.

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Article Information

Accepted for Publication: May 11, 2020.

Published: June 5, 2020. doi:10.1001/jamanetworkopen.2020.11192

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Mortus JR et al. JAMA Network Open.

Corresponding Author: Todd K. Rosengart, MD, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS: BCM 390, Houston, TX 77030 (todd.rosengart@bcm.edu).

Author Contributions: Drs Mortus and Rosengart had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mortus, Manek, Loor, Cruz, Trautner, Rosengart.

Acquisition, analysis, or interpretation of data: Mortus, Manek, Brubaker, Rosengart.

Drafting of the manuscript: Mortus, Manek, Brubaker, Cruz, Rosengart.

Critical revision of the manuscript for important intellectual content: Mortus, Manek, Brubaker, Loor, Trautner, Rosengart.

Statistical analysis: Mortus.

Administrative, technical, or material support: Brubaker, Loor, Trautner.

Supervision: Rosengart.

Conflicts of Interest Disclosures: Dr Cruz reported being the founder of A2 Therapeutics and owning patent No. 7879793. Dr Trautner reported receiving grants from the Agency for Healthcare Research and Quality, Department of Veterans Affairs (VA) Health Services Research and Development Service, Rehabilitation Research and Development, and Zambon Pharmaceuticals and personal fees from Paratek outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Brubaker is supported by grant No. T32 HL139425 from the National Institutes of Health and National Heart, Lung, and Blood Institute. Dr Trautner is supported in part by grant No. 13-413 from the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center, Houston, Texas. Dr Cruz is supported in part by the Merit Review Award I01 BX002551 from the US Department of Veterans Affairs Biomedical Laboratory Research and Development Service.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the US government.

Additional Contributions: Wei Qi, MS, provided statistical analysis for this study. Miriam King, MEd, assisted with manuscript preparation. Robert Southard, MD, and Yesenia Rojas-Khalil, MD (Baylor St Luke Medical Center); and Laila Eugenia Woc-Colburn, MD, and Meredith Reyes, MD (Baylor College of Medicine) assisted in developing material related to this study. They were not compensated for their contributions.

References

Han H , Yang L , Liu R , et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. Published online March 16, 2020;/j/cclm.ahead-of-print/cclm-2020-0188/cclm-2020-0188.xml. doi:10.1515/cclm-2020-0188 PubMed Google Scholar

Tang N , Bai H , Chen X , Gong J , Li D , Sun Z . Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-1099. doi:10.1111/jth.14817 PubMed Google Scholar Crossref

Thachil J , Tang N , Gando S , et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-1026. doi:10.1111/jth.14810 PubMed Google Scholar Crossref

Geerts W . Central venous catheter-related thrombosis. Hematology Am Soc Hematol Educ Program. 2014;2014(1):306-311. doi:10.1182/asheducation-2014.1.306 PubMed Google Scholar Crossref

Klok FA , Kruip MJHA , van der Meer NJM , et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;(April):S0049-3848(20)30120-1. doi:10.1016/j.thromres.2020.04.013 PubMed Google Scholar

Dolhnikoff M , Duarte-Neto AN , de Almeida Monteiro RA , et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost. Published online April 15, 2020. doi:10.1111/jth.14844 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.