Abstract Number: PB0226
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: Hypercoagulability and pulmonary microvascular thrombosis has been related to COVID-19 hypoxemia. Rotational thromboelastometry (RT) could identify the procoagulant state.
Aims: – To evaluate maximum clot firmness(MCF) and other RT parameters among COVID-19 patients in intensive care unit(ICU) compared to healthy controls(HC)
– To compare them according to mechanical ventilation (MV) requirement
Methods: Prospective observational cohort study (August-November 2020). ICU cohort: all adult patients admitted due to COVID-19. HC cohort: healthy volunteers.
Coagulation profile was evaluated by RT NaHEPTEM assay in ROTEM Delta at day 1 (T1), 5 (T5) and 10 (T10) from ICU admission. D-Dimer and Fibrinogen were also evaluated.
Results: Twenty three COVID-19 patients (under prophylactic dose enoxaparin) and 19 HC were included. MCF was statistically higher in ICU patients vs HC at admission (T1) and further increasing at T5. (table 1)
Distribution of NaHEPTEM parameters, DD and Fibrinogen in samples from ICU patients under MV or not are shown in figure 1. ICU patients under MV compared to non-MV presented higher levels of fibrinogen from T1 to T10, DD and MCF at T5,and shorter clotting formation time (CFT), higher maximum velocity (MaxV) and 5 minutes Amplitude (A5) at T1. Maximum Lysis (ML) was significantly lower at T5 and T10 compared to T1, p=0.003 and P=0.008, respectively, but not associated with MV. (table1).
COVID-19 patients discharged from hospital before T10 (n=5) presented at T5 significant lower values of DD, Fibrinogen and RT MaxV compared to patients with longer UCI stay.
| Table 1. Laboratory findings on different time points. Abbreviations: MV: mechanical ventilation; CT: Clotting time; CFT: Clotting formation time; A5: Amplitude at 5 min; MCF: Maximum clot firmness; ML: Maximum lysis; MaxV: maximum velocity of clot formation. ap=0.051; bp=0.058; cp=0.019; dp=0.022; ep<0.001; fp=0.042 | |||||||
|---|---|---|---|---|---|---|---|
| HC (n = 19) |
T1 non-MV (n = 12) |
T1 MV (n = 11) |
T5 non-MV (n = 8) |
T5 MV (n = 15) |
T10 non-MV (n = 4) |
T10 MV (n = 13) |
|
| CT, seg | 568 (473 – 613) | 577 (493 – 647) | 582 (493 – 619) | 462 (423 – 508) | 540 (439 – 593) | 480 (404 – 510) | 509 (444 – 548) |
| CFT, seg | 154 (134 – 207) | 173 (153- 223)a | 113 (95 – 174)a | 139 (114 – 151) | 125 (93 – 149) | 122 (98 – 148) | 126 (102 – 139) |
| A5, mm | 33 (30 – 39) | 34 (29 – 38)b | 45 (34 – 51)b | 41 (39 – 43) | 45 (40 – 53) | 36 (33 – 39) | 50 (40 – 58) |
| MCF, mm | 56 (52 – 60) | 64 (56- 66) | 64 (61- 71) | 65 (64 – 67)c | 70 (68 – 71)c | 66 (61 – 69) | 70 (67 – 74) |
| ML, % | 8 (5 – 10) | 9 (6 – 14) | 10 (7 – 14) | 9 (7 – 10) | 6 (4 – 10) | 6 (4 – 10) | 6 (3 – 11) |
| MaxV, mm/min | 8 (7 – 10) | 8 (7 – 9)d | 12 (9 – 16)d | 11 (9 – 12) | 13 (10 – 15) | 11 (9 – 15) | 12 (10 – 15) |
| Platelets x 109/L | 249 (222 – 265) | 261 (173- 317) | 231 (194 – 269) | 356 (307 – 444) | 279 (243 – 319)* | 296 (286 – 313) | 273 (208 – 354) |
| D-Dimer, ng/ml FEU | – | 750 (562- 1286) | 1032 (540 – 1395) | 421 (273 – 776)e | 2340 (1419 – 4079)e | 1691 (1302 – 2008) | 1874 (1529 – 1980) |
| Fibrinogen, mg/dL | 311 (280 – 354) | 456 (423 – 542)f | 579 (487 – 682)f | 354 (315 – 373)e | 568 (510 – 647)e | 437 (351 – 502) | 605 (547 – 696) |
Table 1. Laboratory findings on different time points. Abbreviations: MV: mechanical ventilation; CT: Clotting time; CFT: Clotting formation time; A5: Amplitude at 5 min; MCF: Maximum clot firmness; ML: Maximum lysis; MaxV: maximum velocity of clot formation. a p=0.051; b p=0.058; c p=0.019; d p=0.022; e p<0.001; f p=0.042
Figure 1. Distribution of hemostatic parameters: D-Dimer (a) and fibrinogen (b), as well as NaHEPTEM parameters CFT(c), MaxV(d), A5(e) and MCF (f) in all blood samples performed from ICU patients with COVID-19, according to the need of mechanical ventilation treatment. Dashed lines indicated the parameter median obtained in the healthy control group
Conclusions: NaHEPTEM assay could detect hypercoagulability among COVID-19 critically ill patients. Velocity parameters(CFT, MaxV) and A5 seem to be further altered in patients that required MV at early stages after ICU admission, probably reflecting increased thrombin generation. MCF and DD were higher at T5 post ICU admission in patients under MV. ML decreased along to study period without association to MV and no difference to HC. Further studies are needed to evaluate its clinical usefulness.
To cite this abstract in AMA style:
Carboni Bisso I, Huespe I, Las Heras M, Prado E, Garbarini M, López MS, Barrera L, Sinner J, Martinuzzo M. Hypercoagulable Rotational Thromboelastometry NaHEPTEM Profile is Related to Mechanical Ventilation Requirement among Critically ill COVID-19 Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/hypercoagulable-rotational-thromboelastometry-naheptem-profile-is-related-to-mechanical-ventilation-requirement-among-critically-ill-covid-19-patients/. Accessed September 24, 2023.« Back to ISTH 2021 Congress
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