Markers of coagulation and hemostatic activation aid in identifying causes of cryptogenic stroke

Nahab, Fadi; Sharashidze, Vera; Liu, Michael; Rathakrishnan, Priyadharshi; Jamal, Sleiman El; Duncan, Alexander; Hoskins, Michael; Marmarchi, Fahad; Belagaje, Samir; Bianchi, Nicolas; Belair, Trina; Henríquez, Laura; Monah, Kaslyn; Rangaraju, Srikant

doi:10.1212/wnl.0000000000009365

Cited by 21 publications

(29 citation statements)

References 17 publications

(25 reference statements)

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“…Patients received prophylactic anticoagulation therapy upon admission, per the Emory VTE prophylaxis guidelines [ 8 ]. Prophylactic anticoagulation therapy was not shown to have a significant influence on the MOCHA profile [ 9 ]. Electronic medical records were retrospectively reviewed from admission through discharge or until the censor date of September 14, 2020 to identify venous and arterial thrombotic events.…”

Section: Methodsmentioning

confidence: 99%

“…A biomarker panel called the markers of coagulation and hemostatic activation (MOCHA), which includes plasma D-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer levels, has been shown to predict subsequent diagnosis of new malignancy, VTE, and other hypercoagulable states in patients with cryptogenic stroke [ 9 , 10 ]. A previous study has also demonstrated that a MOCHA profile with < 2 marker abnormalities can effectively rule out hypercoagulable states in patients with embolic stroke of undetermined source [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Validation of an admission coagulation panel for risk stratification of COVID-19 patients

et al. 2021

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Background There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications. Methods Hospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality. Main results Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ≥ 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2–8.8) as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5–6.6) and ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6–7.9). However, only ≥ 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7–5.2) and intubation (OR 3.2, 95% CI 1.6–6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint. Conclusions An admission MOCHA profile is useful to risk-stratify COVID-19 patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of an admission coagulation panel for risk stratification of COVID-19 patients

et al. 2021

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“…The number of abnormal MOCHA results has been used to determine hypercoagulable state in patients with stroke. 9 , 15 This investigation was deemed as an exempt protocol by the institutional review board. Deidentified tables with raw data are presented as a Supplementary Table (all supplemental materials can be found at American Journal of Clinical Pathology online).…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies have shown significantly higher rates of coagulopathy-related morbidity and mortality in patients with two or more elevated MOCHA parameters compared with patients with elevation of one MOCHA parameter. 15 , 16 …”

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confidence: 99%

Retrospective Analyses Associate Hemostasis Activation Biomarkers With Poor Outcomes in Patients With COVID-19

Moosavi

Wooten

Goodman

et al. 2020

American Journal of Clinical Pathology

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Objectives Patients with coronavirus disease 2019 (COVID-19) have thromboembolic complications. Assessment of coagulation and other markers could be useful to understand their coagulopathy. Methods We performed a retrospective study of inflammatory and coagulation parameters, including prothrombin fragment 1.2 (PF1.2), thrombin-antithrombin complexes (TATs), fibrin monomers, and D-dimer, in hospitalized patients with COVID-19. We compared the markers in patients with thrombosis, admission to the intensive care unit (ICU), and poor outcome. Results Of the 81 patients, 9 (11%) experienced an acute thrombotic event (4 with pulmonary embolism, 3 with venous thrombosis, and 2 with stroke). PF1.2 was elevated in 32 (39%) patients, TATs in 54 (67%), fibrin monomers in 49 (60%), and D-dimer in 76 (94%). Statistically significant elevation in PF1.2 and TATs was seen in patients admitted to the ICU, while D-dimer and fibrin monomers were significantly elevated in patients with poor outcomes. The presence of multiple abnormal coagulation parameters was associated with ICU admission. Other parameters with statistically significant results included abnormal WBC counts and elevated C-reactive protein, which were associated with ICU admission and poor outcomes. Conclusions Our data demonstrate that abnormalities of biomarkers of hemostasis activation and inflammatory markers are associated with poor outcomes in patients with COVID-19.

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“…7,8 A biomarker panel called the markers of coagulation and hemostatic activation (MOCHA), which includes plasma D-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer levels, has been shown to predict subsequent diagnosis of new malignancy, VTE, and other hypercoagulable states in patients with cryptogenic stroke. 9,10 A previous study has also demonstrated that a MOCHA profile with < 2 marker abnormalities can effectively rule out hypercoagulable states in patients with embolic stroke of undetermined source. 11 The objective of this study was to determine whether the admission MOCHA profile in hospitalized COVID-19 patients could aid in risk stratification by identifying those patients at low versus high risk of vascular thrombotic events, ICU admission, intubation and clinical outcome more effectively than D-dimer alone.…”

Section: Introductionmentioning

confidence: 98%

Markers Of Coagulation And Hemostatic Activation Identify COVID-19 Patients At High Risk For Thrombotic Events, ICU Admission and Intubation

Alabyad

Rangaraju

Liu

et al. 2020

Preprint

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Background: Coronavirus disease 2019 (COVID-19) has been associated with a coagulopathy giving rise to venous and arterial thrombotic events. The objective of our study was to determine whether markers of coagulation and hemostatic activation (MOCHA) on admission could identify COVID-19 patients at risk for thrombotic events and other complications. Methods: COVID-19 patients admitted to a tertiary academic healthcare system from April 3, 2020 to July 31, 2020 underwent standardized admission testing of MOCHA profile parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer) with abnormal MOCHA defined as ≥ 2 markers above the reference. Prespecified thrombotic endpoints included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, and access line thrombosis; other complications included ICU admission, intubation and mortality. We excluded patients on anticoagulation therapy prior to admission and those who were pregnant. Results: Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American race) who met study criteria, 45 (16%) had a thrombotic event. Each coagulation marker on admission was independently associated with a vascular endpoint (p<0.05). Admission MOCHA with ≥ 2 abnormalities (n=203, 74%) was associated with in-hospital vascular endpoints (OR 3.3, 95% CI 1.2-8.8), as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6), and admission D-dimer ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only admission MOCHA with ≥ 2 abnormalities was associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4), while admission D-dimer ≥ 2000 ng/mL and admission D-dimer ≥ 3000 ng/mL were not associated. MOCHA and D-dimer cutoffs were not associated with mortality. Admission MOCHA with <2 abnormalities (26% of the cohort) had a sensitivity of 88% and negative predictive value of 93% for a vascular endpoint. Conclusions: Admission MOCHA with ≥ 2 abnormalities identified COVID-19 patients at increased risk of ICU admission and intubation during hospitalization more effectively than isolated admission D-dimer measurement. Admission MOCHA with <2 abnormalities identified a subgroup of patients at low risk for vascular events. Our results suggest that an admission MOCHA profile can be useful to risk-stratify COVID-19 patients.

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Markers of coagulation and hemostatic activation aid in identifying causes of cryptogenic stroke

Cited by 21 publications

References 17 publications

Validation of an admission coagulation panel for risk stratification of COVID-19 patients

Validation of an admission coagulation panel for risk stratification of COVID-19 patients

Retrospective Analyses Associate Hemostasis Activation Biomarkers With Poor Outcomes in Patients With COVID-19

Markers Of Coagulation And Hemostatic Activation Identify COVID-19 Patients At High Risk For Thrombotic Events, ICU Admission and Intubation

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