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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Comprehensive Coagulation Profiling via iCoagLab in Patients Treated with Impella Pumps Daniel Hoare, Aniket Joshi, Eli Foster, Nathaniel Hai, Ziqian Zeng, Seemantini Nadkarni. Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA |
Abstract
Background Percutaneous Impella pumps provide prolonged partial ventricular unloading in patients with cardiogenic shock and those undergoing high-risk percutaneous coronary interventions. Although technology is lifesaving, patients are exposed to elevated bleeding risk. Maintaining haemostasis in patients on Impella pumps is challenging due to rapidly changing coagulation conditions, requiring coagulation monitoring. Conventional coagulation tests (CCTs) take too long, require large blood volumes and often are unreliable in these high acuity clinical settings. There is a need for a point-of-care analyzer that provides comprehensive, actionable coagulation information within minutes at the bedside to guide treatment decisions. iCoagLab is a hand-sized device that measures clot viscoelasticity from laser intensity fluctuations of scattered light to assess comprehensive coagulation parameters using a small volume of whole-blood (~25mL), in <10min. Here, we evaluate iCoagLab in Impella-supported patients, comparing results with CCTs. To investigate the role of clot architecture on clot viscoelasticity we further utilize multivariate linear regression to relate iCoagLab parameters to fibrin microstructure visualized by spectrally-encoded confocal microscopy(SECM). Objective Our objective is to evaluate the relationship between iCoagLab coagulation parameters and CCTs and thromboelastography(using TEG6S) in Impella-supported patients. Secondly, we determine the association between fibrin clot microarchitecture and clot viscoelasticity measured by viscoelastic profiling and CCT. Methodology We conducted iCoagLab testing in N=37 whole blood 17 patients with percutaneous cardiac pumps (Impella, Abiomed, Danvers, MA) and compared iCoagLab coagulation parameters with CCTs and TEG6S(Fig1). Whole blood samples from the Massachusetts General Hospital hematology laboratory were tested. Coagulation was initiated with kaolin (intrinsic assay) and with recombinant human tissue factor (extrinsic assay). iCoagLab measurements of reaction time, R; activated clotting time, ACT; clot rate, angle; and mechanical strength, MA, prothrombin time, PT; and fibrinogen, FIB were reported(Fig1B-D). iCoagLab values were compared with corresponding TEG6S, and CCT (Werfen-ACL-Top350) values. Structural analysis was performed using SECM where platelet-poor plasma was initiated with CaClâ‚‚ and kaolin. Images were captured every 7secs for 60mins to measure Fibrin Time, after which a 3D stack was acquired for clot analysis. Four key parameters: fiber density, straightness, length, and heterogeneity were obtained and compared to TEG6S, iCoagLab and CCTs. Results Statistically significant correlations were observed between iCoagLab-R-Time and ACT with TEG6S-R-Time (r=0.56, p<0.001, N=37) and (r=0.64, p<0.001, N=35) respectively. iCoagLab-FIB correlated with TEG6s-FLEV(r=0.68, p<0.0001, N=47) and CCT-Fibrinogen(r=0.67, p<0.0001, N=74). Further comparisons of iCoagLab-PT with CCT-PT (r=0.61, p<0.0001, n=64) and iCoagLab-ACT with CCT-aPTT(r=0.51, p<0.0001, n=70) were also significant (Fig2). Fibrin microstructural parameters, particularly structural density measured by SECM were closely associated with the clot viscoelastic parameter, iCoagLab-MA(r=0.64, p<0.05) and TEG6S-MA(r=0.66, p<0.05). Further analysis showed anti-Xa levels significantly correlated with straighter fibrin fibers(Fiber Straightness, r=0.70, p<0.00005). A model combining fiber density with fiber heterogeneity raised the explanatory power for predicting MA to R²=0.53(Fig2G-H). Conclusions Our results confirm the high accuracy of iCoagLab in quantifying actionable clotting parameters within 10mins in patients with Impella using a small volume of whole blood. These studies will help pave the way towards addressing life-threatening bleeding complications swiftly at the point-of-care.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.