Thromboelastography-Guided Management of Anticoagulated COVID-19 Patients to Prevent Hemorrhage
John E. Stillson, Connor M. Bunch, Laura Gillespie, Rashid Khan, Meredith Wierman, Joseph Pulvirenti, Htay Phyu, Stephen Anderson, Mahmoud D. Al-Fadhl, Anthony V. Thomas, Hau C. Kwaan, Ernest E. Moore, Hunter B. Moore, Mark Walsh
Abstract
Major hemorrhage is an underreported complication of hospitalized and anticoagulated patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (i.e., the pathogen causing novel coronavirus disease 2019 [COVID-19]). Recent evidence demonstrates some degrees of hypercoagulability in these patients, prompting an expanding group of institutions to establish guidelines recommending intermediate or therapeutic doses of low-molecular weight heparin (LMWH) or unfractionated heparin (UFH) for COVID-19 patients with moderate to severe pneumonia.[1] [2] [3] [4] [5] [6] [7] Monitoring hemostatic competence of COVID-19 patients is quite challenging, because their initial hypercoagulability can be quickly supplanted by hypocoagulability in the presence of anticoagulation or even hemostasis exhaustion.[1] [8]