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Correlation between heparin anti-Xa activity and thromboelastography in adult critically ill COVID-19 patients

Mitchell S Buckley1, Grace E Benanti2, Brian Gilbert3

  • 1Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA.

Pharmacotherapy
|May 18, 2023
PubMed

Insights

This study examined unfractionated heparin (UFH) monitoring in severe COVID-19 patients. It found a correlation between anti-Xa levels and thromboelastography (TEG) R time, aiding anticoagulation management.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Severe coronavirus disease 2019 (COVID-19) is associated with an increased risk of thrombotic complications.
  • Unfractionated heparin (UFH) is frequently used for venous thromboembolism (VTE) management in these patients.
  • Optimal anticoagulation intensity and monitoring parameters for intensive care unit (ICU) COVID-19 patients remain unclear.

Purpose of the Study:

  • To evaluate the relationship between anti-Xa activity and thromboelastography (TEG) R time in severe COVID-19 patients receiving therapeutic UFH infusions.
  • To explore correlations between activated partial thromboplastin time (aPTT) and TEG R time.
  • To describe clinical outcomes associated with these monitoring parameters.

Main Methods:

  • Single-center, retrospective study conducted over 15 months (2020-2021) at an academic medical center.
  • Included adult patients with severe COVID-19 receiving therapeutic UFH infusions.
  • Analyzed paired anti-Xa and TEG assessments drawn within 2 hours, and aPTT/TEG R time correlations using Pearson's coefficient and kappa measure of agreement.

Main Results:

  • A correlation was observed between anti-Xa levels and TEG R time in severe COVID-19 patients on therapeutic UFH.
  • Secondary analyses explored the correlation between aPTT and TEG R time.
  • Clinical outcomes were also described in relation to these coagulation parameters.

Conclusions:

  • The study provides insights into the relationship between different anticoagulation monitoring methods in severe COVID-19.
  • Findings may help inform optimal anticoagulation strategies and monitoring in critically ill COVID-19 patients.
  • Further research is warranted to validate these findings and guide clinical practice.
Abstract

Keywords:
COVID-19TEGanticoagulationcritical careheparinintensive care unitthromboelastography

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