63: D-Dimer and Fibrinogen Magnitude and Hypercoagulability by Thromboelastography in Severe COVID-19

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated with a high rate of thrombotic complications related to an acute inflammatory state D-dimer has been established as a marker of disease severity in COVID-19 Despite a paucity of data, D-dimer concentration has been used by institutions to identify candidates for intensified anticoagulant treatment for prevention and mitigation of the thrombotic complications associated with COVID-19 Thromboelastography (TEG) maximum amplitude (MA) has been validated as a marker of hypercoagulability with previous research defining hypercoagulability by a TEG MA ≥ 68 mm We examined the relationship between common clinical laboratory parameters and hypercoagulability as represented by TEG MA METHODS: We performed a single center retrospective analysis of consecutive patients who received ECMO for the treatment of COVID-19 with simultaneous TEG, coagulation, and inflammatory markers (D-dimer, fibrinogen, ferritin, and C-reactive protein) drawn during hospitalization TEG MA values and inflammatory markers were compared in patients with and without a thrombotic complication during admission Correlation tests were performed to identify the coagulation and inflammatory markers that may predict hypercoagulability as defined by elevated TEG MA RESULTS: 168 TEGs were available in 24 patients C-reactive protein and fibrinogen were significantly higher in patients that developed a thrombotic event versus those that did not (p=0 038 and p=0 043 respectively) There was no difference in D-dimer between groups (p=0 312) D-dimer was negatively correlated with TEG MA (p 441 mg/dL had high diagnostic accuracy (sensitivity of 91 2%, specificity of 85 7%) for the detection of MA ≥ 68 mm CONCLUSIONS: In critically ill patients with COVID-19, D-dimer had an inverse relationship with hypercoagulability as measured by TEG MA D-dimer elevation may reflect severity of COVID-19 related sepsis rather than designate patients likely to benefit from anticoagulation Fibrinogen concentration may represent a more useful marker of hypercoagulability in this population