TY - JOUR T1 - Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2020-000603 VL - 7 IS - 1 SP - e000603 AU - James K Choi AU - Kartik Prabhakaran AU - Rifat Latifi AU - Abbas Smiley AU - Joshua Klein AU - Gary Lombardo AU - Peter Rhee Y1 - 2022/03/01 UR - http://tsaco.bmj.com/content/7/1/e000603.abstract N2 - Background Clinical hypercoagulopathy in patients with COVID-19 has been anecdotally described, but there is lack of evidence due to the novelty of this disease. Our study reports the results of rotational thromboelastography (ROTEM) in relation to traditional laboratory coagulation tests and acute phase markers among a cohort of severely ill, mechanically ventilated patients with COVID-19.Methods Patients with COVID-19 (N=21) with respiratory failure requiring mechanical ventilation were included in this prospective case series. ROTEM was serially obtained for all patients on three different days during their intensive care unit (ICU) stay and analyzed using repeated measures analysis. Demographic variables, symptoms at the time of presentation, ROTEM values, laboratory values for traditionally measured coagulation profiles, and acute phase reactants were analyzed, in addition to the use of anticoagulation and clinical hypercoagulopathic complications.Results The average age of our cohort was 57.9 years old (SD=14.4) and 76.2% were male. The mortality rate was 14.3% (3 of 21). Two patients (12.5%) were identified to have new-onset deep vein thrombosis, two patients (12.5%) were found to have ≥3 episodes of central venous catheter thrombosis, and three patients (18.7%) had confirmed stroke. ROTEM demonstrated elevated EXTEM and INTEM clotting times, including elevated FIBTEM maximum clot firmness (MCFFIB). All patients treated with therapeutic anticoagulation still demonstrated hypercoagulopathy within the MCFFIB tests.Discussion Repeated measure ROTEMs were able to detect hypercoagulopathy in ICU patients with COVID-19 despite therapeutic anticoagulation with heparin.Level of evidence III.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All of the de-identified individual participant data reported in this article will be made available, including the study protocol and statistical analysis plan, beginning 9 months and ending 36 months after article publication. Data will be shared with investigators whose proposed use of data has been approved by an independent review committee identified for this purpose. Proposals may be submitted up to 36 months after article publication. ER -