Abstract Number: PB0097
Meeting: ISTH 2022 Congress
Background: COVID-19 associated coagulopathy (CAC) has been associated with an increase in venous thromboembolic events. Most guidelines advise heparins in the management of this coagulopathy. However, the relative effectiveness of this strategy on the coagulation potential of COVID-19 patients remains unclear.
Aims: We aim to describe the development of COIVID-19 associated coagulopathy in patients treated with either low molecular weight heparins (LMWH) or unfractionated heparin (UFH) during the course of disease in an intensive care unit population. Additionally we evaluate the anticoagulant treatment in these patients in-vitro.
Methods: We included 33 patients with confirmed COVID-19 admitted at the ICU. Calibrated automated thrombinography (CAT) was measured at least twice over the course of 6 weeks after admission. Thrombin generation results were subsequently correlated with an extensive database of clinical and laboratory measurements.
Results: Anti-Xa levels of all patients remained within their therapeutic range throughout the follow-up. The mean (SE ) endogenous thrombin potential (ETP) was 1727 (170) nM.min and 1620 (460) nM.min for ellagic acid (EA) and tissue factor (TF) respectively at inclusion. In line with this we found a mean (SE) PH of 352.9 (44.9) nM and 263.5 (95.7) nM for EA and TF. Despite adequate treatment thrombin generation parameters remained highly elevated. In vitro assessment alternative anticoagulants showed promising aspects of direct thrombin inhibition.
Conclusion(s): We showed that, in a cohort of critically ill COVID-19 patients on low molecular weight heparins, despite apparent adequate anti-coagulation doses evaluated by antiXa levels, thrombin generation potential remains high. Thrombin generation potential persists over the course of ICU admission and is independent of age, sex, body mass index, APACHE II score, cardiovascular disease and smoking status. The observations could, for a small part at the most, be explained by (anti)coagulation and thrombosis, inflammation and multi-organ failure. Direct thrombin inhibition might be a promising alternative anticoagulant therapy in COVID-19.
To cite this abstract in AMA style:van de Berg T, Mulder M, Alnima T, Spronk H, van Oerle R, Beckers E, Hackeng T, Hulshof A, Sels J, Henskens Y, van der Horst I, ten Cate H, van Bussel B. Serial thrombin generation, while on LMWH prophylaxis in critically ill COVID-19 patients from the prospective MaastrICCht cohort. [abstract]. https://abstracts.isth.org/abstract/serial-thrombin-generation-while-on-lmwh-prophylaxis-in-critically-ill-covid-19-patients-from-the-prospective-maastriccht-cohort/. Accessed September 22, 2023.
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