Abstract Number: PB0263
Meeting: ISTH 2021 Congress
Background: Venovenous (vv)-extracorporeal membrane oxygenation (ECMO) support is used as rescue therapy in COVID-19 patients with severe acute respiratory distress syndrome (ARDS). However, COVID-19 is associated with a hypercoagulable state with high rates of thrombosis. Whether ECMO implantation exacerbates COVID-19-associated coagulopathy is unknown.
Aims: To perform a longitudinal evaluation of whole blood viscoelastic properties throughout the course of vv-ECMO in COVID-19 ARDS patients.
Methods: 20 COVID-19 patients undergoing vv-ECMO were included in this prospective study. Blood was sampled before ECMO implantation and then 24 hours and 7 days after ECMO implantation. SEER Sonorheometry was performed on a Quantra® hemostasis analyzer with the QPlus® Cartridge (HemoSonics LLC). All patients received UFH to a target anti-Xa activity of 0.3-0.5 IU/mL.
Results: The median age was 48 (42-58) years, with a median body mass index of 30.5 (28.2-38.5) Kg/m², and 15 (71%) patients were men. The median SAPSII and SOFA scores on admission were 52.5 (44.3-65.5) and 12.0 (8.5-15.8), respectively. Baseline clot times (CT) and baseline clot times with heparinase (CTH) were within the normal range [median 150 (127-178) sec and 129 (118-151) sec, respectively] and did not vary throughout the course of ECMO. COVID-19 patients exhibited markedly increased baseline values of clot stiffness [CS, median 49.9 (35.5-69.2 hPA)], fibrinogen contribution to CS [FCS, median 12.80 (6.20-20.10) hPA] and platelet contribution to CS [PCS, median 38.5 (28.7-52.4) hPA]. CS, FCS and PCS decreased from baseline to day 7. CT significantly correlated with aPTT (r=0.75, p<0.0001), FCS with fibrinogen levels (r=0.81, p<0.0001) and PCS with platelet count (r=0.85, p<0.0001) but result delivery was much faster with the Quantra® analyzer compared to conventional tests (~15 versus ~60 minutes).
Conclusions: COVID-19 patients with ARDS exhibited a pronounced baseline procoagulant state that partially resolved over the first 7 days of ECMO support.
To cite this abstract in AMA style:Lejeune M, Hekimian G, Masi P, Lebreton G, Chommeloux J, Desnos C, Pineton De Chambrun M, Martin-Toutain I, Nieszkowska A, Bréchot N, Schmidt M, Luyt C-, Leprince P, Combes A, Frere C. Longitudinal Measurement of Whole Blood Viscoelastic Properties throughout the Course of Extracorporeal Membrane Oxygenation in COVID-19 Patients with Severe Acute Respiratory Distress Syndrome [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/longitudinal-measurement-of-whole-blood-viscoelastic-properties-throughout-the-course-of-extracorporeal-membrane-oxygenation-in-covid-19-patients-with-severe-acute-respiratory-distress-syndrome/. Accessed December 5, 2021.
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