763 Hemostasis changes among COVID-19 gravidas during SARS-CoV-2 pandemic on rotational thromboelastography

Abstract

The novel coronavirus infection, COVID-19, is characterized by an exaggerated inflammatory response that is reported to manifest as coagulopathy in up to 50% of severe cases. Despite a majority of patients receiving low-molecular weight heparin (LMWH), data suggests a high incidence of venous thromboembolic events (VTEs). Pregnancy is a hypercoaguable state that predisposes gravidas to VTEs. Rotational thromboelastography (ROTEM) is a point-of-care viscoelastic device that uses whole blood sample to define coagulation and fibrinolysis in a particular patient. It is shown to be useful in evaluating clot kinetics in trauma and acutely bleeding patients. This study aims to describe the hypercoaguable effect of COVID-19 in gravidas using ROTEM. A prospective observational study was employed to collect ROTEM parameters (EXTEM, INTEM, FIBTEM) between May and September 2020 from gravidas on admission for labor or scheduled delivery at Yale-New Haven Hospital. ROTEM was run for panels EXTEM (extrinsic hemostasis), INTEM (intrinsic hemostasis), FIBTEM (fibrin assay). One way ANOVA was performed to assess mean differences in ROTEM parameters between COVID-positive and COVID-negative term gravidas at the time of hospital admission. Thirty-nine samples were collected from 19 COVID-positive women and 20 COVID-negative women as the control. Of all standard measurements, the significant findings were: A10 (clot firmness at 10 minutes) [F(2)) = 18.3, p = 0.0001],Mean COVID - = 69.8; Mean COVID + = 61.6;ALPHA (angle between baseline and clotting curve) [F (2)= 4.13, p = 0.05], Mean COVID - = 77.3, Mean COVID + = 74.7;CFT (clot formation time) [F(2) = 5.6, p = 0.02],Mean COVID- = 63.7,Mean COVID + = 79.3 These observations support the that COVID-positive gravidas are more hypercoaguable than their COVID-negative matches.Though statistical significance is demonstrated in this early data, a more robust exploration of this population is needed to determine whether clinical significance exists as well in this at-risk group.