Clot waveform of APTT has abnormal patterns in subjects with COVID-19

Area of Science:

• Hematology
• Infectious Diseases
• Coagulation Science

Background:

• Growing evidence suggests Coronavirus disease 2019 (COVID-19) is associated with distinct coagulation abnormalities.
• Understanding these hemostatic alterations is crucial for managing COVID-19 complications.

Purpose of the Study:

• To investigate specific clot waveform modulations in COVID-19 subjects using routine Activated Partial Thromboplastin Time (APTT) tests.
• To differentiate COVID-19-associated coagulopathy from other hemostatic disorders.

Main Methods:

• Analysis of the second derivative of absorbance from APTT tests performed on an ACL-TOP system.
• Classification of abnormal APTT second-derivative curve patterns (early shoulder, late shoulder, biphasic).
• Comparison of patterns between COVID-19 subjects, disseminated intravascular coagulation (DIC), lupus anticoagulant, hemophilia, and factor IX deficiency.

Main Results:

• High frequencies of abnormal APTT second-derivative patterns (early shoulder, late shoulder, biphasic) were observed in COVID-19 subjects.
• Elevated maximum first and second derivative peak levels and a low minimum second derivative peak level were noted in COVID-19.
• These specific modulations were not present in DIC but were seen in lupus anticoagulant, hemophilia, and factor IX deficiency.
• Abnormal patterns peaked around 2 weeks post-COVID-19 onset and were independent of disease severity.
• Plasma fibrinogen levels may influence these abnormal APTT waveforms.

Conclusions:

• COVID-19 is associated with specific, identifiable abnormal coagulopathy patterns detectable by APTT clot waveform analysis.
• These findings suggest a unique hemostatic profile in COVID-19 that differs from established coagulopathies like DIC.
• Further research into the mechanisms and clinical implications of this COVID-19-associated coagulopathy is warranted.