P0322 Global coagulation assays for the assessment of hypercoagulable states in Inflammatory Bowel Diseases.
Authors: Rueda Garcia J L , Monzón Manzano E , Acuña P , Martín - Arranz E , Suárez Ferrer C , Poza Cordón J , Sánchez - Azofra M , García Ramírez L , Arias-Salgado E G , García - Rojas C , Noci J , Cubillo García C , Butta N , Martín - Arranz M D ,   IdiPAZ Study Group for Immune-Mediated Gastrointestinal Diseases
Published: January 2025

Abstract

Background
Inpatients with Inflammatory Bowel Disease (IBD) are at risk for thromboembolic events, but the risk for flaring outpatients is less understood1. Global Coagulation Assays (GCA) (Thrombin generation assay using Calibrated Automated Thrombogram [CAT] and Rotational Thromboelastometry [ROTEM]) have emerged as aiding tools in the assessment of hypercoagulable states2.

Methods
Cross sectional, case-control study of IBD outpatients, both Crohn’s Disease (CD) and Ulcerative Colitis (UC). Clinical activity indices (Simple Clinical Colitis Activity Index [SCCAI] for UC and Harvey-Bradshaw Index [HBI] for CD) and biomarkers (c-reactive protein [CRP] and fecal calprotectin [FC]) were registered. Exclusion criteria for IBD patients are listed under table 1. CAT values (endogenous thrombin potential [ETP], lag time [lt], peak, time to peak [ttp]) were compared between the IBD group vs healthy controls (HC) after incubation with PPP-Reagent LOW, MP-reagent and PRP-reagent. ROTEM values (clotting time [CT], clot formation time [CFT], alpha angle, maximum clot firmness [MCF], maximum velocity time [MaxVT] and lysis index at 30 min [LI30]) were assessed using the Non-Activated Thromboelastometry (NATEM) assay and compared with reference values. Heat maps and linear regression were modeled to assess for significant correlation and/or association between continuous variables.

Results
55 patients (27 CD, 28 UC) and 75 HC have been included. Baseline characteristics of the IBD population are described in Table 1. No differences were regarded in CAT values between the IBD group vs HC, or IBD ROTEM values vs normal ranges (Figure 1). Significant correlation was found between the following variables (all p values &lt;0.05): CAT-peak with PPPlow and MP-reagent with CRP (ρ=0.38 and ρ=0.32, respectively), CAT-ETP with CRP (ρ=0.28), CAT-peak after incubation with the three agents and SCCAI (ρ=0.5 with PPPlow, ρ=0.5 with MP-reagent and ρ=0.42 with PRP-reagent), CAT-ttpeak and SCCAI (ρ=-0.46), ROTEM-ct and CRP (ROTEM-ct and SCCAI (ρ=–0.38) and ROTEM-MaxVT and SCCAI (ρ=-0.45). Linear regression showed significant association of CAT-peak (after incubation with all three agents) with SCCAI (ß=14.25 for PPP-LOW, ß=22.92 for MP-reagent and ß=13.006 for PRP-reagent, all p values &lt;0.05), ROTEM-MaxVT with SCCAI (ß=-26.1, p=0.01) and ROTEM-ct with SCCAI (ß=-18.02, p=0.02). No other significant associations or correlations were found.

Conclusion
Correlation of GCA values with CRP and SCCAI suggests enhanced thrombin generation and clot formation in symptomatic outpatients with UC, although overall CAT and ROTEM values are similar in IBD and HC groups. No correlation/association was found between CAT and ROTEM variables with Fcal (globally) or HBI in CD.

References
1.Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohn’s Colitis. 2023 Jun 23;1–76.
2.Hartmann J, Hermelin D, Levy JH. Viscoelastic testing: an illustrated review of technology and clinical applications. Res Pract Thromb Haemost [Internet]. 2023;7(1):100031