PB0097 - Serial thrombin generation, while on LMWH prophylaxis in critically ill COVID-19 patients from the prospective MaastrICCht cohort.

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Tv

Tom van de Berg

Phd Student
Department of BIochemistry, Cardiovascular Research Institute Maastricht, Maastricht University
Maastricht, Limburg, Netherlands

Co-Author(s)

MM

Mark Mulder

Fellow intensive care
ICU, Maastricht University Medical Centre +, The Netherlands
Maastricht, Limburg, Netherlands
TA

Teba Alnima

Staff member internal medicine
Radboud hospital Nijmegen
Nijmegen, Gelderland, Netherlands
HS

Henri M.H. Spronk

Chief Executive Officer
Coagulation Profile, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
Rv

René van Oerle

Chief Operating Officer
Coagulation Profile, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
EB

Erik A.M. Beckers

Head of Haematology
Department of Hematology, Maastricht University Medical Center + and Maastricht University, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
TH

Tilman M. Hackeng, PhD

Chief Scientific Officer
Coagulation Profile, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
AH

Anne-Marije Hulshof, BSc

Medical student/pHD
Maastricht University Medical Centre +, The Nerherlands
Maastricht, Limburg, Netherlands
JS

Jan-Willem Sels

Intensivist
ICU, Maastricht University Medical Centre +, The Netherlands
Maastricht, Limburg, Netherlands
Yvonne Henskens, MSc PhD

Professor in Clinical Chemistry, Clinical chemist
Central Diagnostic Laboratory at Maastricht University Medical Centre+
Maastricht, Limburg, Netherlands
Iv

Iwan C.C. van der Horst

Professor, head of the department of intensive care at Maastricht University Medical Centre+
Maastricht University Medical Centre+
Maastricht, Limburg, Netherlands
Hugo ten Cate, MD, PhD, FAHA

Professor, MD, PhD
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
Bv

Bas van Bussel

Staff member Internal medicine/ ICU
MUMC+
Maastricht, Limburg, Netherlands

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.