Optimization of Thrombinemia Laboratory Diagnostics in COVID-19-Patients

ABSTRACT

Introduction. Currently used and available in real clinical practice, laboratory tests do not allow an objective and reliable assessment of risk and severity of thrombinemia, prothrombotic readiness, and, as a result, does not allow to choose the appropriate optimal antithrombotic therapy regimen (administration of prophylactic or therapeutic anticoagulant doses) in relation to the screening of this condition in severe COVID-19. Objective: analysis of prothrombotic readiness in COVID-19-patients by integral method — thrombin generation (kinetics) assay. Materials and Methods. A prospective clinical and laboratory study included 100 patients (average age was 63 [31–85] years, 60 women, 40 men) with an identified SARS-CoV-2 virus with moderate and severe course of novel coronovirus infection. Parameters of thrombin generation (kinetics) assay — clotting initiation time (tLag), time of thrombin peak formation (tPeak), thrombin peak (Peak), endogenous thrombin potential (ETR;area under the thrombin formation curve, AUC) were determined, as well as levels of fibrinogen, D-dimer, ferritin, C-reactive protein (CRP), activated partial thromboplastin time (APTT), prothrombin time (PT), international normalized ratio (INR). Results. The results of thrombin kinetics assay pointed to an increased blood procoagulant potential in COVID-19-patients on admission to the hospital;correlations were found between tLag and fibrinogen (rS = –0.7;p = 0.001), tLag and CRP (rS = –0.1;p = 0.01);between tPeak and all inflammation markers — D-dimer (rS = –0.4;p = 0.001), ferritin (rS = –0.2;p = 0.01), CRP (rS = –0.3;p = 0.05), fibrinogen (rS = –0.5;p = 0.001);between Peak and fibrinogen (rS = 0.3;p = 0.001);between rate index (VI) and fibrinogen (rS = 0.2;p < 0.001);between AUC and fibrinogen (rS = 0.4;p = 0.001), AUC and CRP (rS = 0.1;p = 0.001). Conclusion. Thrombin generation (kinetics) assay can be considered as a marker of thrombinemia — prothrombotic readiness in patients with moderate and severe course of novel coronovirus infection. © 2023, Hemostasis and Rheology LLC. All rights reserved.