Related Experiment Video
Updated: Sep 24, 2025
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
COVID-19-related dynamic coagulation disturbances and anticoagulation strategies using conventional D-dimer and
Madhumita Premkumar1, Sekar Loganathan2, Kamal Kajal3
1Department of Hepatology, Postgraguate Institute of Medical Education and Research, Chandigarh, India.
Insights
COVID-19 pneumonia can cause a heparin-like effect (HLE), a coagulation abnormality. This HLE is linked to increased need for mechanical ventilation and higher mortality in severe cases.
Area of Science:
- Coagulation disorders
- Critical care medicine
- Infectious diseases
Background:
- COVID-19 is associated with hypercoagulable states and thromboembolic complications.
- Understanding coagulation abnormalities is crucial for managing severe COVID-19.
Purpose of the Study:
- To assess the dynamic association of COVID-19-related coagulation abnormalities with respiratory failure and mortality.
- To evaluate the role of point-of-care coagulation tests in predicting outcomes.
Main Methods:
- Prospective cohort study of 74 treatment-naive ICU patients with COVID-19 pneumonia.
- Utilized Sonoclot assays to assess coagulation parameters and identify heparin-like effect (HLE).
- Logistic regression and Cox proportional hazards tests analyzed predictors of mortality.
Main Results:
- A heparin-like effect (HLE) was present in over 50% of patients by day 3.
- HLE predicted the need for mechanical ventilation (HR 1.2).
- HLE, elevated C-reactive protein, and decreased platelet function predicted 28-day mortality.
Conclusions:
- Heparin-like effect (HLE) is a significant finding in severe COVID-19 pneumonia.
- HLE is associated with increased need for invasive ventilation and mortality.
- Point-of-care coagulation testing can aid in risk stratification.
Objectives:
Coagulation changes associated with COVID-19 suggest the presence of a hypercoagulable state with pulmonary microthrombosis and thromboembolic complications. We assessed the dynamic association of COVID-19-related coagulation abnormalities with respiratory failure and mortality.
Design:
Single-centre, prospective cohort study with descriptive analysis and logistic regression.
Setting:
Tertiary care hospital, North India.
Participants:
Patients with COVID-19 pneumonia requiring intensive care unit (ICU) admission between August 2020 and November 2020.
Primary And Secondary Outcome Measures:
We compared the coagulation abnormalities using standard coagulation tests like prothrombin time, D-dimer, platelet count, etc and point-of-care global coagulation test, Sonoclot (glass beaded(gb) and heparinase-treated(h)). Incidence of thromboembolic or bleeding events and presence of endogenous heparinoids were assessed. Cox proportional Hazards test was used to assess the predictors of 28-day mortality.
Measurement:
All patients underwent Sonoclot (glass beaded) test at admission apart from the routine investigations. In patients at risk of thromboembolic or bleeding phenomena, paired tests were performed at day 1 and 3 with Sonoclot. Activated clotting time (ACT) <110 s and peak amplitude >75 units were used as the cut-off for hypercoagulable state. Presence of heparin-like effect (HLE) was defined by a correction of ACT ≥40 s in h-Sonoclot.
Results:
Of 215 patients admitted to ICU, we included 74 treatment naive subjects. A procoagulant profile was seen in 45.5% (n=5), 32.4% (n=11) and 20.7% (n=6) in low-flow, high-flow and invasive ventilation groups. Paired Sonoclot assays in a subgroup of 33 patients demonstrated the presence of HLE in 17 (51.5%) and 20 (62.5%) at day 1 and 3, respectively. HLE (day 1) was noted in 59% of those who bled during the disease course. Mortality was observed only in the invasive ventilation group (16, 55.2%) with overall mortality of 21.6%. HLE predicted the need for mechanical ventilation (HR 1.2 CI 1.04 to 1.4 p=0.00). On multivariate analysis, the presence of HLE (HR 1.01; CI 1.006 to 1.030; p=0.025), increased C reactive protein (HR 1.040; CI 1.020 to 1.090; p=0.014), decreased platelet function (HR 0.901; CI 0.702 to 1.100 p=0.045) predicted mortality at 28days.
Conclusion:
HLE contributed to hypocoagulable effect and associated with the need for invasive ventilation and mortality in patients with severe COVID-19 pneumonia.
Trial Registration:
NCT04668404; ClinicalTrials.gov.in. Available from https://clinicaltrials.gov/ct2/show/NCT04668404.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:09Coagulation
During the coagulation phase, clotting factors, or procoagulants, play a vital role in initiating and progressing the coagulation cascade. This cascade is a series of reactions...