Darwish Alabyad1, Srikant Rangaraju2, Michael Liu2, Rajeel Imran2, Christine L Kempton3, Milad Sharifpour4, Sara C Auld5,6, Manila Gaddh3, Roman Sniecinski7, Cheryl L Maier8, Jeannette Guarner8, Alexander Duncan8, Fadi Nahab9. 1. Morehouse School of Medicine, Atlanta, Georgia, United States of America. 2. Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America. 3. Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States of America. 4. Division of Critical Care Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America. 5. Emory Critical Care Center, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America. 6. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America. 7. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America. 8. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America. 9. Department of Neurology & Pediatrics, Emory University, Atlanta, Georgia, United States of America.
Abstract
BACKGROUND: There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications. METHODS: Hospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality. MAIN RESULTS: Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ≥ 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2-8.8) as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6) and ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only ≥ 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint. CONCLUSIONS: An admission MOCHA profile is useful to risk-stratify COVID-19 patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.
BACKGROUND: There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19patients at risk for thrombotic events and other complications. METHODS: Hospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality. MAIN RESULTS: Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ≥ 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2-8.8) as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6) and ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only ≥ 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint. CONCLUSIONS: An admission MOCHA profile is useful to risk-stratify COVID-19patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.
Authors: Michael Karsy; Mohammed A Azab; Jonathan Harper; Hussam Abou-Al-Shaar; Jian Guan; Ilyas Eli; Andrea A Brock; Ryan D Ormond; Patrick W Hosokawa; Ramkiran Gouripeddi; Ryan Butcher; Chad D Cole; Sarah T Menacho; William T Couldwell Journal: World Neurosurg Date: 2019-10-09 Impact factor: 2.104
Authors: Toshiaki Iba; Jerrold H Levy; Jean Marie Connors; Theodore E Warkentin; Jecko Thachil; Marcel Levi Journal: Crit Care Date: 2020-06-18 Impact factor: 9.097
Authors: M Sakka; J M Connors; G Hékimian; I Martin-Toutain; B Crichi; I Colmegna; D Bonnefont-Rousselot; D Farge; C Frere Journal: J Med Vasc Date: 2020-05-27