Abstract Number: PB0222
Meeting: ISTH 2021 Congress
Background: Anticoagulant thromboprophylaxis is recommended for all hospitalized COVID-19 patients. However, the dosage regimen is debated, as thrombogenicity may vary in different patients and during the course of infection.
Aims: 1. Conduct observational study of various hemostatic tests to achieve accurate dynamic monitoring in COVID-19 patients. 2. Evaluate effectiveness of heparin therapy correction in response to the ongoing changes in hemostasis system.
Methods: 1. Hemostasis was monitored in 1,859 patients with severe COVID-19 in seven hospitals in Moscow. Blood was taken at hospital admission before the start of thromboprophylaxis and every 1-3 days throughout the treatment. To minimize the presence of heparin in blood sample, blood was collected 12 hours after heparin injection. Hemostasis was investigated using APTT, INR, D-dimer test, Thromboelastography and Thrombodynamics.
2. Correction of heparin therapy was carried out in 218 COVID-19 patients monitored using Thrombodynamics in three hospitals.
Results: 1. APTT and INR parameters did not change after the start of heparin therapy and indicated hypocoagulation during entire thromboprophylaxis. D-dimer was strongly elevated in most patients but was also unchanged during the therapy. Thromboelastography and Thrombodynamics showed hypercoagulability in 60-70% of patients prior to therapy. Subsequently, these tests revealed normal coagulation in 70% of the patients. From all examined hemostatic tests, the most sensitive indicator of the state of hemostasis was the rate of clot growth determined with Thrombodynamics.
2. Based on the results of the observational study, heparin therapy was corrected in ICU patients to maintain the rate of clot growth at 12-20 μm/min, as determined with Thrombodynamics. Thrombotic complications were observed in 19% of patients, compared with 32% in the control group with 151 patients, who received standard heparin therapy with no correction.
Conclusions: Dynamic monitoring of hemostasis via Thrombodynamics in patients with severe COVID-19 enables effective correction of heparin therapy, significantly reducing thrombotic complications.
To cite this abstract in AMA style:Ataullakhanov F, Shakhidzhanov S, Nechipurenko D, Serebrisky I, Karamzin S, Spiridonov I, Zateyshchikov D, Panteleev M, Mustyatsa V, Morozova D, Koltsova E, Seregina E, Ratchina S, Gubkin A, Martyanov A, Grishchuk E, Protsenko D, Tsarenko C, Vasilieva H, Rumyantsev A. Dynamic Monitoring of Hemostasis and Correction of Heparin Therapy Can Halve the Number of Thrombotic Complications in Patients with Severe COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/dynamic-monitoring-of-hemostasis-and-correction-of-heparin-therapy-can-halve-the-number-of-thrombotic-complications-in-patients-with-severe-covid-19/. Accessed September 23, 2021.
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