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175: Thromboelastography (TEG) Informs Anticoagulation Management in Hospitalized Patients With COVID-19

INTRODUCTION: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have a high incidence of thrombotic complications We hypothesized that thromboelastography (TEG) could diagnose hypercoagulable state and inform anticoagulation management in patients with COVID-19 METHODS: We conducted a retrospective observational epidemiologic study of COVID-19 patients over the age of 18, admitted to an academic tertiary care center in Richmond, Virginia, between March and June 2020, and with at least one TEG in the electronic medical record A SARS-CoV-2 infection was confirmed with a nasopharyngeal polymerase chain reaction We tabulated and classified the anticoagulation (AC) regimens and constructed an epidemiological summary of TEG values, patient characteristics, and COVID-19 patient outcomes RESULTS: Out of the 55 COVID-19 patients that were admitted to the hospital during the study period, ten (18 2%) developed thrombi: Deep vein thromboses 12 7%, arterial thrombus 3 6%, pulmonary embolism 1 8%, and splenic vein thrombus 1 8% Fifty patients (91%) had a hypercoagulable TEG, and 42 (76 3%) required ICU level of care, while 30 (54 5%) required mechanical ventilation At the time of initial TEG, 11 patients (20%) were on no AC, 24 (44%) were on standard AC, 11 (20%) were on high dose AC, and 8 (15%) were on therapeutic AC Thirty-nine patients (71%) had a low R time, 33 (60%) had normal K time, 38 (69%) had increased alpha angle, and 33 (60%) had increased max amplitude The hypercoagulable TEG profile informed the escalation of the AC to high-dose in 17 (31%), compared to 20% pre-TEG, and therapeutic AC in 28 (51%), compared to 15% pre-TEG The TEG-guided intensification to therapeutic AC led to normalization of TEG parameters: 1 (10%) had reduced R time, vs 80% at baseline, 1 (10%) had reduced K time, vs 40%, 6 (60%) had increased alpha angle (vs 68%), and 5 (50%) had increased max amplitude (vs 60%) CONCLUSIONS: Our results suggest that nearly all TEGs performed in patients hospitalized with severe COVID-19 diagnosed a hypercoagulable state The TEG profiles informed the clinical decision to initiate, change, or modify the anticoagulation regimens Further studies are needed to elucidate the role of TEG in COVID-19 thrombotic events and clinical outcomes