PB0169 - Direct relation between hypercoagulability and high fibrinogen levels measured by thrombelastography in patients with high-risk coronary artery disease and COVID-19

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

UT

Udaya Tantry

Director, Thrombosis Research Laboratory
Sinai Center for Thrombosis Research and Drug Development
Baltimore, Maryland, United States
KB

Kevin Bliden

Director, Clinical Trials
Sinai Center for Thrombosis Research and Drug Development
Baltimore, Maryland, United States
DS

Damian Sidorski

Research Fellow
Sinai Center for Thrombosis Research
Baltimore, Maryland, United States
SS

Sahib Singh

Research Fellow
Sinai Center for Thrombosis Research
Baltimore, Maryland, United States
LR

Lekshmi Narayan Raghavakurup

Research Fellow
Sinai Center for Thrombosis Research
Baltimore, Maryland, United States
TS

Taylor Stude

Research Fellow
Sinai Center for Thrombosis Research
Baltimore, Maryland, United States
RS

Roni Shanoada

Research Fellow
Sinai Center for Thrombosis Research and Drug Development
Baltimore, Maryland, United States

Co-Author(s)

PG

Paul Gurbel

Director, Sinai Center for Thrombosis Research
Sinai Center for Thrombosis Research and Drug Development
Baltimore, Maryland, United States

Presenting Author(s)

JD

Jeffrey Dahlen, PhD

President
Hikari Dx
San Diego, California, United States

Background: Hypercoagulability indicated by high platelet-fibrin clot strength is an established risk factor for post-PCI thrombotic events in coronary artery disease (CAD) patients. COVID-19 is characterized by high fibrinogen levels and high platelet-fibrin clot strength. Direct relation between Thrombin-induced platelet-fibrin clot strength (Thrombin PF-CS) and fibrinogen in patients with CAD and COVID-19 has not been studied.

Aims: To study the direct relation between Thrombin PF-CS and fibrinogen measured by thromboelastography in patients with coronary artery disease and COVID-19.

Methods: Thrombin PF-CS in the presence of kaolin, tissue factor induced CS in the presence of platelet glycoprotein inhibitor (abciximab) (indicator of fibrinogen-CS) and functional fibrinogen levels were measured in healthy subjects in high risk hospitalized patients with CAD and with COVID-19. Relation between thrombin PF-CS, fibrinogen-CS and fibrinogen levels were assessed by regression analysis. Hypercoagulability was indicated by Thrombin PF-CS >66mm, fibrinogen-CS >32mm and fibrinogen >581 mg/dL.

Results: The study cohort included 310 subjects (healthy subjects=157, COVID-19 pts=116 and CAD pts=37) with 54% male and 47% African Americans. Average age was 51+/-18 years, thrombin PF-CS=64+/- 6mm, fibrinogen CS=30+/-13 mm and functional fibrinogen levels 536+/-228 mg/dL. Compared to healthy volunteers, prevalence of hypercoagulability was higher among patients with CAD (≤11% vs. 43%, p< 0.05) and was highest among patients with COVID-19 (≤11% vs. 71%, p< 0.01) (Table). Both fibrinogen-CS and functional fibrinogen levels were significantly associated with thrombin PF-CS (R2 =0.798 and 0.779, respectively) (Figure).

Conclusion(s): Patients with CAD and COVID-19 have higher prevalence of hypercoagulability, an established risk factor for thrombosis. Thrombin PF-CS was significantly associated fibrinogen-CS and fibrinogen levels indicating that fibrinogen is an important driving factor in addition to platelet reactivity for thrombotic event occurrences and safer strategies to lower fibrinogen levels including antiinflammatory agents should be explored.