444 - Coagulation assessment in COVID-19 (Coronavirus disease 2019) pregnant women and their neonates by using Rotational Thromboelastometry (ROTEM)

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 444
Publication Number: 444.431

Georgios Mitsiakos, 2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Dimitra Gialamprinou, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Athanasios Moraitis, Papageorgiou General Hospital, Thessaloniki, Thessaloniki, Greece; Georgios Katsaras, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Christos-Georgios Kontovazainitis, Aristotle University of Thessaloniki, Athens, Attiki, Greece; Abraham Pouliakis, 2nd Department of Pathology / National and Kapodistrian Unversity of Athens, Athens, Attiki, Greece; Christos Zymperdikas, Papageorgiou Hospital of Thessaloniki, Lagkadas, Thessaloniki, Greece; Anastasia -. Mpanti, PAPAGEORGIOU GH, THESSALONIKI, Thessaloniki, Greece; Theodoros Theodoridis, ARISTOTLE UNIVERSITY OF THESSALONIKI, GREECE, THESSALONIKI, Thessaloniki, Greece; Grigorios Grimbizis, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece

Presenting Author(s)

GM

Georgios Mitsiakos

Associate Professor of Paediatrics - Neonatology
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki
Thessaloniki, Thessaloniki, Greece

Background: ROTEM has been carried out extensively in adults to assess sepsis-induced coagulopathy. COVID-19 can be complicated by coagulopathy, also termed COVID-19-associated coagulopathy (CAC). Data concerning CAC in pregnancy and born neonates are limited.

Objective: The aim of this study was to assess coagulation in COVID-19 pregnant women and their neonates by using ROTEM and Conventional Coagulation Tests (CCTs).

Design/Methods: A prospective cohort study was conducted from December 2021 to July 2022. Pregnant women with confirmed COVID-19 were assessed 2 hours before delivery. Their neonates were assessed in the first hour of life and in the 4^th day of life. CCTs and ROTEM assays were used. Matched healthy mothers and their neonates served as control group (Table 1).

Results:

Forty-six COVID-19 positive pregnant women and 47 neonates were included and compared to 22 healthy pregnant women and their 22 neonates respectively. COVID-19 pregnant women present higher APTT and fibrinogen values (p 0.024 and 0.008). In FIBTEM they present higher A10, MCF, and alpha angle (p 0.002, 0.002, and 0.021) and shorter CFT (p 0.001) compared to the healthy group. In subgroup analysis of febrile COVID-19 women (18 subjects) FIBTEM showed similar results and moreover shorter EXTEM CFT and higher EXTEM alpha angle (p 0.033 and 0.017) (Table 2).
Neonates born from COVID-19 women (febrile and no febrile), in the first day of life, they had higher PT and INR (p 0.014 and 0.016), while in their fourth day of life they had higher D-dimers (p 0.006) compared to healthy controls. In FIBTEM they present shorter CT in the first day of life (p 0.017). Neonates born from febrile COVID-19 women present lower EXTEM and INTEM A10 in the first day of life (p 0.002), and lower INTEM LI60 in the fourth day of life (p 0.020) (Table 2).

Conclusion(s): COVID-19 pregnant women presented hyrecoagulability in ROTEM along with elevated fibrinogen indicative of infection-induced inflammation. Interestingly none of those women presented bleeding or thrombosis complication although on heparin prophylaxis protocol. Conversely, in neonates born from COVID-19 mothers findings from ROTEM assays presented neither hypercoagulability nor hypocoagulability suggesting that placenta remains intact and the fetus unaffected by a potential infection-induced cytokine storm. CCTs in the study group in both mothers and neonates showed hypocoagulability, nevertheless these tests is widely accepted that have failed to reveal hypercoagulability state.