PB0062 - Rotational thromboelastometry in heparin monitoring in critical COVID-19 disease.

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

LS

Lejan Schulting

Intensivist
ICU, Maastricht University Medical Centre +
Maastricht, Limburg, Netherlands

Presenting Author(s)

AH

Anne-Marije Hulshof, BSc

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

Co-Author(s)

MM

Mark Mulder

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

Jan-Willem Sels

Intensivist
ICU, Maastricht University Medical Centre +, The Netherlands
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
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
Bv

Bas van Bussel

Intensivist
ICU and Care and Public Health Research Institute, Maastricht University Medical Centre+, Maastricht, 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

Background: Critically-ill COVID-19 patients on UFH present with heparin resistance (defined as >35.000 IU/day) to reach target aPTT or aXa. APTT is the conventional method as aXa is time consuming and not widely available. APTT or aXa relate differently to doses of UFH, which questions their validity in COVID-19 disease. Whole-blood rotational thromboelastometry (ROTEM) INTEM/HEPTEM clotting time (CT) ratio could be a more functional alternative.

Aims: Observational study comparing ROTEM INTEM/HEPTEM CT ratio, aPTT and anti-Xa in mechanically ventilated COVID-19 patients on UFH/LMWH.

Methods: We studied a subcohort (n=106/232) of mechanically ventilated COVID-19 patients of the MaastrICCht cohort. We measured ROTEM, aPTT and aXa on UFH (n=18) or therapeutic LMWH ( n=88). Patients received UFH (ECMO/renal replacement therapy) or therapeutic LMWH (venous thromboembolism/cardiac arrhythmia). ROC and Linear regression analyses were assessed for diagnostic characteristics and associations.

Results: INTEM/HEPTEM CT ratio was significantly higher in UFH-patients (1.4 [1.3-1.4]) compared to LMWH-patients (1.0 [1.0-1.1], p< 0.001) (Table 1). Furthermore, ROC analysis showed an AUC of 0.935 for INTEM/HEPTEM CT ratio, 0.775 for aPTT and 0.632 for aXa, suggesting that INTEM/HEPTEM CT ratio detects presence of UFH more accurately than aPTT and aXa. At an INTEM/HEPTEM CT cut-off of 1.1, sensitivity was 87.5% and specificity was 86.3% for the detection of UFH. Both APTT and aXa were positively associated with INTEM/HEPTEM CT ratio (β(95%CI) 0.006(0.004-0.008) and 0.153 (0.071-0.234) respectively, Table 2).Only, the association between aXa and INTEM/HEPTEM CT ratio was significantly stronger (p=0.006) in UFH-patients (β(95%CI) 0.310 (0.001-0.619), compared to LMWH-patients (β(95%CI) 0.094 (0.053-0.135).

Conclusion(s): ROTEM INTEM/HEPTEM CT ratio can detect the presence of UFH opposed to the presence of therapeutic LMWH in mechanically ventilated COVID-19 patients. INTEM/HEPTEM CT ratio was dependent on aPTT, irrespective of UFH or LMWH use. The association between aXa and INTEM/HEPTEM CT ratio was significantly stronger in patients on UFH than LMWH.