UCLouvain, CHU UCLouvain/UNamur
" Evaluation of the thrombotic risk associated with SARS-CoV-2 infection and its management in the intensive care unit: a clinical and biological longitudinal study. Background Since the beginning of SARS-CoV-2 outbreak in December 2019, data accumulate regarding the high thrombotic risk associated with this infection, which could explain substantial part of the observed morbidity and mortality (1). Accordingly, a retrospective study suggested that prophylactic anticoagulation could reduce mortality in severe COVID-19 patients with sepsis-induced coagulopathy (2). Furthermore, a European cohort reported a 27% incidence of venous thrombo-embolisms (VTEs) despite systematic prophylactic anticoagulation, raising the question whether deeper anticoagulant regimen would be beneficial in severe COVID-19 (3). Some authors also suggested that fibrinolysis alterations could be a significant determinant of SARS-CoV-2 infection's prognosis, as it is in conventional ARDS (4). Mechanisms underlying these haemostatic alterations have not been comprehensively studied yet. The extreme inflammatory response observed in severe cases could explain at least part of the procoagulant and possibly hypofibrinolytic status. This high inflammatory status also interferes with coagulation tests such as activated partial thromboplastin time (aPTT) usually used for heparin treatment monitoring, making the management of high anticoagulant regimens more complicated. More advanced tests such as chromogenic measurement of anti -Xa or anti-IIa activity, or thrombin generation (TG) could be more appropriate in this context. In the end, few data are available regarding haemostatic alterations associated with SARS-CoV-2 infection, making it difficult to produce guideline for the management of these patients. Data are urgently needed to determine how to optimally manage these patients. Objectives (i) To compare analytical performances of aPTT, anti-Xa or anti-IIa activity and TG in COVID-19 patients to identify the most appropriate method to tailor anticoagulant therapy. (ii) To measure the evolution of the haemostatic profile of COVID-19 patients admitted to the ICU to identify biomarkers that could be used to evaluate the need for deeper anticoagulant regimens and its duration. (iii) To evaluate the presence and prognostic value of fibrinolytic alterations associated with severe SARS- CoV-2 infection, and to identify patients that could benefit from more advanced fibrinolytic therapies. "
Funding: Namur Thrombosis and Hemostasis Center (confirmed) FNRS (to be confirmed)
Contact: Prof François Mullier This email address is being protected from spambots. You need JavaScript enabled to view it.