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Author Notes:


Dr. Nahab has United States Patent Application 20200147125 on the detection of high risk arterial thromboembolic diseases by markers of coagulation and hemostatic activation. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Darwish Alabyad: Data curation, Formal analysis, Writing – original draft

Srikant Rangaraju, Rajeel Imran, Christine L. Kempton, Milad Sharifpour, Manila Gaddh: Methodology, Writing – review & editing

Michael Liu: Formal analysis, Writing – review & editing

Sara C. Auld: Formal analysis, Methodology, Writing – review & editing

Roman Sniecinski: Investigation, Writing – review & editing

Cheryl L. Maier, Fadi Nahab: Conceptualization, Methodology, Writing – review & editing

Alexander Duncan, Jeannette Guarner: Conceptualization, Writing – review & editing


Research Funding:

The authors received no specific funding for this work.


  • Aged
  • Antithrombin III
  • Area Under Curve
  • COVID-19
  • Cohort Studies
  • Female
  • Fibrin Fibrinogen Degradation Products
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Admission
  • Peptide Fragments
  • Peptide Hydrolases
  • Prothrombin
  • ROC Curve
  • Risk Factors
  • SARS-CoV-2
  • Survival Rate
  • Thrombosis

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

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Journal Title:



Volume 16, Number 3 March


, Pages e0248230-e0248230

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2021 Alabyad et al

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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