Novel, low-volume, point-of-care coagulation test successfully detects anticoagulation resistance in hospitalized patients with COVID-19
Circulation
; 144(SUPPL 1), 2021.
Article
in English
| EMBASE | ID: covidwho-1632401
ABSTRACT
Introduction:
Severe COVID-19 has been associated with aberrant coagulation factor activities, particularly in patients with a thrombotic event (TE). Management of anticoagulant is critical in the care of hospitalized patients with COVID-19.Hypothesis:
Evaluation of a point-of-care (POC), functional, clot-time-based coagulation test to detect the anticoagulant effect of therapeutic unfractionated heparin (UFH) in hospitalized SARS-CoV-2-positive patients who developed a TE.Methods:
An IRB-approved analysis of 36 citrated plasma specimens from 26 SARS-CoV-2-positive patients and 10 matched negative controls was performed. A Clotting Time Score (CTS), a measure of factor-specific inhibition (i.e. anticoagulant activity), was derived for each patient. CTS results were compared with traditional coagulation tests. Five UFH COVID-19 samples with low CTS scores (<10) were spiked with uniform dosing of UFH, low molecular weight heparin (LMWH), apixaban, or argatroban and retested to assess anticoagulation response.Results:
The CTS detected subtherapeutic UFH anticoagulation levels more frequently in COVID-19 cases compared with controls (76% vs. 17%). Prothrombin Times, activated Partial Thromboplastin Times, anti-Xa levels, and antithrombin activity did not correlate with each other or with the CTS in the COVID-19 samples. CTS correlated with both FV and Factor X activity (R =0.49, Spearman R=-0.68), which form the prothrombinase complex. The CTS was 94% sensitive and 67% specific for the occurrence of TEs in patients on UFH. CTS demonstrated a consistent anticoagulant response only to argatroban (100%) compared with other anticoagulants (60%).Conclusions:
The CTS, generated using a novel, low-volume, rapid POC coagulation test is a strong indicator of the therapeutic effect of UFH anticoagulation in COVID-19 patients and may provide a predictive measure of TEs potentially occurring from anticoagulation resistance.
antithrombin; apixaban; argatroban; blood, clotting, factor, 10; endogenous, compound; heparin; low, molecular, weight, heparin; activated, partial, thromboplastin, time; adult; anticoagulation; blood, clotting, test; clinical, article; conference, abstract; controlled, study; drug, therapy; female; hospital, patient; human; human, tissue; male; nonhuman; prothrombin, time; Severe, acute, respiratory, syndrome, coronavirus, 2; therapy, effect
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Circulation
Year:
2021
Document Type:
Article
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