Abstract Number: VPB0129
Meeting: ISTH 2022 Congress
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/hr (65,000 IU/day), see figure one. With the prolonged R time, heparin was descalated to 16 IU/kg/hr 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.
To cite this abstract in AMA style: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 [abstract]. https://abstracts.isth.org/abstract/thromboelastography-six-redefining-heparin-resistance-in-post-covid-syndrome/. Accessed February 21, 2024.
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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thromboelastography-six-redefining-heparin-resistance-in-post-covid-syndrome/