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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| iCoagLab Measures Comprehensive Coagulation Profiles Within Minutes in Cardiac Intensive Care Patients Daniel Hoare1, Jay Saggu2, Rusul Al-Ani2, Kristen Warren2, Aniket Joshi1, Christoph Nabzdyk2, Seemantini Nadkarni1. 1Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.2Division of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA |
Abstract
Background: Recovery following cardiac surgery in the intensive care unit(ICU) is pervaded by increased bleeding and thrombotic risk. Peri-operative bleeding and thrombotic risk can be attributed to vascular injury, fibrinolytic activation, high-shear stresses from cardiopulmonary bypass pumps and anticoagulant administration. As such, monitoring coagulation rapidly and accurately at the bedside is crucial for managing bleeding and thrombotic in patients admitted to the ICU. Conventional coagulation tests(CCTs) are used to guide treatment; but, utility of the tests is limited due to prolonged turnaround times, which makes clinical management imprecise because results are retrospective rather than at the time of treatment. While viscoelastic monitoring using TEG is available, the utility of these devices is limited by large blood volume, long test durations and requirement for citrated blood. iCoagLab, is a recent innovation that addresses the unmet clinical need for rapid and actionable coagulation monitoring at the point-of-care in the ICU. The iCoagLab is a low cost, hand sized coagulation profiler that requires just 25µL of whole blood and returns comprehensive coagulation parameters in <10mins. The device uses inexpensive disposables where blood is mixed with lyophilised reagents. A laser illuminates the sample while a CMOS camera analyses laser speckle intensity fluctuations caused by the intrinsic motion of endogenous light-scattering particles over time to assess viscoelastic properties of the coagulating samples. In this study, we present the first demonstration of comprehensive coagulation monitoring at the point-of-care in ICU patients using the iCoagLab technology, which reports profiles <10mins at the bedside. Objectives To evaluate the feasibility and clinical utility of point-of-care coagulation profiling using iCoagLab in the cardiac ICU. Methods: Coagulation profiling was conducted in the cardiac ICU in 53 samples from 46 patients using activated kaolin(AK) to interrogate the intrinsic coagulation pathway, a prothrombin time(PT) assay to assess the extrinsic pathway, and a fibrinogen(FIB) assay for fibrinogen quantification. We compared the lyophilised assays in both non-citrated whole blood(NC-WB) and citrated whole blood(C-WB) to assess assay use at the point-of-care. Additionally, the iCoagLab assays used with NC-WB samples were compared to the patient’s standard of care CCT to assess point-of-care profiling. Results: Using NC-WB at the point-of-care for the first time iCoagLab metrics measured parameter showed strong correlations with C-WB results for all metrics(r≥0.65, Fig1C-H). This iCoagLab milestone demonstrated the feasibility of NC-WB use with the iCoagLab. Comparing the iCoagLab parameters to CLTs demonstrated significant correlations across all assays(r≥0.65, Fig2A-D) supporting the clinical applicability of the iCoagLab at the point-of-care for the first time. By utilizing NC-WB at the point-of-care with the iCoagLab is a marked decrease in test result time, blood volume and ease at which results can be obtained potentially leading improved outcomes following larger studies. Conclusions: For the first time the iCoagLab has been demonstrated to acquire multiparametric coagulation profiling at the point-of-care in patients from 25µL of NC-WB in <10mins. This foundational study showed the efficacy of the iCoagLab to deliver the unmet clinical need of rapid comprehensive coagulation profiling in patients at elevated risk of bleeding 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.