Abstract Number: PB0152
Meeting: ISTH 2021 Congress
Background: Synergy between coagulation and inflammation is clear in SARS-CoV-2 infection making patients susceptible to thrombosis.
Numerous articles describe the prognostic value of individual or combined laboratory biomarkers. However, there is no single test that can be used to provide a composite assessment to easily identify and track emerging hypercoagulability. We present two methods via which a single assessment could be used as a global measure of inflammation (NETs) and coagulation (ROTEM).
Aims: Investigate whether patients with COVID-19 demonstrate ROTEM parameters and or elevated NETs markers (H3.1-nucleosomes), indicating hypercoagulability, early in admission. (ii) Whether patients admitted to ITU have a significantly higher Maximum Clot Firmness (MCF) and H3.1-nucleosomes compared to those on the ward.
Methods: Consenting patients were tested for ROTEM on admission and daily for 10 days and weekly thereafter until discharge from hospital. H3.1-nucleosomes were measured at all time points in 3 patients (1 admitted directly to ITU, 1 to ITU during their hospital stay and 1 remaining on the ward) using Nu.Q™ H3.1-nucleosome ELISA (Belgian Volition SRL, Isnes, Belgium) according to the manufacturer’s instruction.
ROTEM demonstrated a hypercoagulable state compared to controls on admission for FIBTEM CT (p<0.001) and MCF (p<0.001), EXTEM CT, CFT, MCF and ML (p<0.002) and INTEM CT (p<0.028), MCF (p<0.004) and ML (p<0.001). In our cohort MCF (p=0.849) was not significantly higher in those admitted to ITU compared to those on the ward however moderate significance was observed in the EXTEM CFT (p=0.051) and EXTEM ML (p=0.056). In the 3 assessed with serial H3.1, the values closely track their clinical course (fig1).
Conclusions: ROTEM measures a hypercoagulable state compared to controls with increased MCFand hypofibrinolysis. Although this is a small, exploratory study, the H3.1 nucleosome findings suggest that it may be able to risk stratify on admission and track clinical course.
To cite this abstract in AMA style:Stanford S, Rea C, Roy A, Harris B, Ashton A, Mangles S, Everington T, Chandrakumaran K, Arbuthnot E, Cecil T. Identifying Tools to Track Hypercoagulability in COVID-19 Patients. Exploring Global Haemostasis (ROTEM) and Neutrophil Extracellular Traps (NETs) Immunoassays [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/identifying-tools-to-track-hypercoagulability-in-covid-19-patients-exploring-global-haemostasis-rotem-and-neutrophil-extracellular-traps-nets-immunoassays/. Accessed September 16, 2021.
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