(1468) Thromboelastography With Platelet Mapping and Gender Dimorphism in COVID-Associated Coagulopathy

Introduction: Coronavirus-19 (Covid)-associated coagulopathy may be characterized by hypercoagulability with increased risk of thrombosis. Research has suggested gender-associated differences possibly secondary to female sex hormones. We hypothesized that Thromboelastography with Platelet Mapping (TEG-PM) would demonstrate hypercoagulability in premenopausal women, leading to increased complications.

Methods: Adult hospitalized patients with COVID-19 were included in this retrospective study and divided into two groups: males and postmenopausal females (M/PF) versus premenopausal females (F). Women older than 55 were designated as postmenopausal. Demographics; thrombotic and hemorrhagic complication rates; initial TEG-PM parameters, and outcomes were collected and analyzed via univariate analysis.

Results: A total of 176 patients were evaluated: 23 premenopausal females (group F), 38 postmenopausal females and 115 males (group M/PF). The groups were well matched on demographics; however, patients in group F were more likely to be obese (BMI 36.7±1.9 vs 30.3±0.6, p=0.0002); M/PF were more likely to be smokers (44(28.8%) vs 1(4.4%), p=0.0123). TEG-PM demonstrated platelet hyperactivity (MA-AA 66.8 ± 2.6 vs 60.7 ± 1.2, p=0.0599) and decreased fibrinolysis (%lysis 1.8 ± 1.1 vs 5.3 ± 0.9, p=0.0138) in group F compared to M/PF. Despite a similar number of thrombotic events, premenopausal women were less likely to be treated with therapeutic anticoagulation (6(26.1%) vs 77(51%), p=0.0259). While there were no differences in proportion of patients admitted to the intensive care unit, all premenopausal women requiring mechanical ventilation died (4(100%) vs 33(71.7%), p=0.2165).

Conclusions: Covid-associated coagulopathy may be characterized by platelet hyperactivity and decreased fibrinolysis in premenopausal women. Higher mortality and decreased use of therapeutic anticoagulants may suggest lower suspicion for hypercoagulability in this younger population. TEG-PM should be used to guide anticoagulation therapy.