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Haemostatic differences between SARS-CoV-2 PCR-positive and -negative patients at the time of hospital admission

1Department of Clinical Chemistry. Meander Medical Center, Amersfoort, Amersfoort, Utrecht, Netherlands, 2Department of Internal Medicine. Meander Medical Center, Amersfoort, Amersfoort, Utrecht, Netherlands, 3Synapse Research Institute, Maastricht, Limburg, Netherlands, 4Synapse Research Institute, Maastricht, the Netherlands, Maastricht, Limburg, Netherlands, 5 Synapse Research Institute, Maastricht, Limburg, Netherlands, 6Department of Medical Microbiology and Medical Immunology. Meander Medical Center, Amersfoort, Amersfoort, Utrecht, Netherlands, 7Department of Pulmonology. Meander Medical Center, Amersfoort, Amersfoort, Utrecht, Netherlands, 8Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands, Maastricht, Limburg, Netherlands

Abstract Number: PB0086

Meeting: ISTH 2022 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a prothrombotic phenotype with an increased risk for thrombosis.

Aims: To investigate whether COVID-19 is associated with changes in coagulation parameters upon presentation at the emergency department and whether these changes are associated with the development of thrombotic complications in patients with SARS-CoV-2 infection.

Methods: A single centre, cross-sectional cohort study: the MArkers in COVID-19 And Relations to Outcomes in the Netherlands (MACARON) study was conducted. All patients suspected of SARS-CoV-2 infection referred to the emergency department of the Meander Medical Center between March-May 2020 were included. 519 patients (26% PCR positive, median age 66 (range 19-97 years), 52.2% male) were included from whom an oro- and nasopharyngeal swab was obtained for detection of SARS-CoV-2 by polymerase chain reaction (PCR). Blood samples for laboratory analysis were obtained from all patients. Thrombosis was defined as a clinical diagnosis of venous thromboembolism or atherothrombotic event based upon radiology and laboratory results.

Results: SARS-CoV-2 PCR positive patients had increased fibrinogen levels (5.41 g/L vs. 4.21 g/L, p < 0.001) and decreased levels of protein C (85.1% vs. 96.1%, P < 0.001) and α2-macroglobulin (4.41 µM vs. 5.11 µM, P < 0.001) compared to the PCR negative patients. In addition, we found more acquired activated protein C resistance in PCR positive patients. Furthermore, we found that elevated levels of factor VIII (208% vs 162%, p=0.028) and von Willebrand Factor (208% vs 186%, p=0.038) and decreased ADAMTS-13 levels (597 ng/mL vs. 691 ng/mL, p < 0.001) were associated with increased occurrence of thrombosis in PCR positive patients (thrombosis vs non-thrombosis).

Conclusion(s): We found that PCR positive patients had a more pronounced prothrombotic phenotype with endothelial activation upon hospital admission showing that coagulation tests may be considered useful to discriminate severe cases of COVID-19 at risk for thrombosis.

To cite this abstract in AMA style:

Remijn J, Traets M, de Laat-Kremers R, Verweij S, Ninivaggi M, Jong E, Huskens D, Blok B, Remme G, Miszta A, Nijhuis R, Herder J, Fijnheer R, Roest M, Fiolet A, de Laat B. Haemostatic differences between SARS-CoV-2 PCR-positive and -negative patients at the time of hospital admission [abstract]. https://abstracts.isth.org/abstract/haemostatic-differences-between-sars-cov-2-pcr-positive-and-negative-patients-at-the-time-of-hospital-admission/. Accessed September 27, 2023.

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