Novel coagulation monitoring at the point of care, for COVID-19 patients
The first Talking Point tackles COVID-19 and the high risk of thromboembolic complications for patients with acute respiratory distress syndrome (ARDS). Those that present with coagulation abnormalities are at far greater risk of severe clotting, with standard treatment protocols unlikely to be sufficient.
We look at the need to quickly identify those at greater risk by running a detailed coagulation profile which includes assessing clot stiffness. And to do this without anyone in the clinical team putting themselves at risk from aerolisation of virus-contaminated blood.
The novel technology underpinning the Quantra viscoelastic analyser enables it to be used safely to characterise a patient’s coagulation profile – doing this at speed, at the point of care, and delivering lab-comparable results within 15 minutes.
Quantra detecting hypercoagulability
Early studies indicate that Quantra can successfully detect features of hypercoagulability in COVID patients with the VET system reporting on increased clot strength, related to both fibrinogen and platelet contribution.
There are also hints that the Quantra could also help tailor treatment.[i] Results suggest that running its clot stiffness parameter would enable the clinician to monitor how well their patient is responding to aggressive thrombotic therapy.
Evidence is mounting that for patients at risk, early intervention with more aggressive thromboprophylaxis using low molecular weight heparin (LMWH) can improve outcomes. Guidance from the ISTH advises clinical teams to monitor coagulation status from the earliest signs of respiratory distress; and then to continue monitoring changes as treatment progresses.
Quantra clot stiffness parameters
Dr. Marco Ranucci from Italy’s San Donato Hospital in Milan used the Quantra in a recent study involving ARDS patients with COVID. He monitored their coagulation profile from the time the patient entered intensive care and for a further two weeks while undergoing aggressive treatment. He noted that running the Quantra clot stiffness parameters (CS, FCS and PCS) showed their return to normal values from a highly increased baseline after 14 days of aggressive therapy.[ii]
Numerous studies[iii] have pointed out that changes in blood coagulation parameters such as D-dimer, platelet count and fibrinogen levels can help identify patients with increased risk of thromboembolic events and predicting outcomes. Indications are that adding VET parameters to the testing portfolio would provide valuable additional insights to detecting and treating seriously ill Covid patients with ARDS.
Safety of closed-cartridge system
Quantra is a viscoelastic testing system that works in a way that stands out from other VET systems, offering the user increased safety. While there has been some earlier use of VET analysers to monitor the coagulation status of ARDS patients, only limited studies have been possible due to this potential risk from handling a blood sample.
The Quantra simply does not have this limitation. Its two cartridges, QPlus and QStat, are fully enclosed and require no pipetting or blood manipulation after collection. This significantly reduces the risk of blood exposure and offers increased safety for staff when evaluating the blood coagulation status in COVID-19 patients.
The value of the close-cartridge system has been confirmed by several US and European hospitals on the COVID frontline. Dr. Florian Raimann of the University Hospital Frankfurt, Germany, has seen first-hand the safety advantages of Quantra. As he explained: “The advantage of the Quantra is that no moving parts come into contact with blood. This is a unique benefit that reduces the risk of infections among our medical staff.”
Accuracy and speed
Quantra is the only whole blood VET system to directly quantify the measuring of clot elasticity, rather than amplitude. Its ‘platelet contribution to clot stiffness’ (PCS) parameter also automatically indicates if platelets are required without the need to spend time calculating this. For more on the unique Quantra parameters, click here.
In less than 15 minutes, the Quantra provides critical information about clotting time and the quality of any formed clot. You can read the results the moment they appear on the screen, without needing to decipher complex curves. Data can also be shared remotely with the blood bank, clinical colleagues or the pathology lab.
Six Quantra parameters
The Quantra QPlus cartridge offers clot time (CT), clot stiffness (CS), clot time with heparinase (CTH) and fibrinogen contribution to clot stiffness (FCS). From these, two unique parameters are then automatically calculated: clot time ratio (CTR), and platelet contribution to clot stiffness (PCS).
Download the full list of clinical papers demonstrating the efficacy of Quantra here.
[i] NATA 2021 Wim Houdijk PhD. Watch here
[ii] Ranucci M et al. J Thromb Haemostat 2020 (April 17)