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Intervention in COVID-19 linked hypercoaguable states characterized by circuit thrombosis utilizing a direct thrombin

Madhav Seshadri1, Jasimuddin Ahamed1,2, Jeffrey Laurence1

  • 1Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA.

Thrombosis Update
|April 15, 2024
PubMed

Insights

Continuous renal replacement therapy (CRRT) in COVID-19 patients often experiences circuit thrombosis. Argatroban, a direct thrombin inhibitor, effectively resolved thrombosis when heparin failed, suggesting a role for high fibrinogen and low anti-thrombin III levels.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Hematology

Background:

  • Circuit thrombosis is a significant complication of continuous renal replacement therapy (CRRT).
  • Standard heparin-based anticoagulation is frequently ineffective in preventing CRRT circuit thrombosis in COVID-19 patients.

Purpose of the Study:

  • To investigate the efficacy of argatroban in managing CRRT circuit thrombosis in COVID-19 patients.
  • To explore potential biomarkers reflecting anticoagulation response in this patient population.

Main Methods:

  • Retrospective case series of five COVID-19 patients experiencing CRRT circuit thrombosis.
  • Patients received argatroban, a direct thrombin inhibitor, after failure of heparin-based anticoagulation.
  • Fibrinogen and D-dimer levels were monitored to assess anticoagulation response.

Main Results:

  • Argatroban successfully resolved circuit thrombosis in all five cases despite prior heparin failure.
  • Changes in fibrinogen levels correlated better with anticoagulation response than D-dimer levels.
  • Elevated fibrinogen and decreased anti-thrombin III activity were observed in these patients.

Conclusions:

  • Argatroban offers a viable alternative for managing CRRT circuit thrombosis in COVID-19 patients refractory to heparin.
  • Fibrinogen levels may serve as a more reliable indicator of anticoagulation efficacy than D-dimer in this context.
  • Underlying hypercoagulable states, characterized by high fibrinogen and low anti-thrombin III, might explain argatroban's superiority.

Keywords:
Direct thrombin inhibitorFibrinogenThrombotic complications

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