Inadequate prophylactic effect of low-molecular weight heparin in critically ill COVID-19 patients
Inadequate prophylactic effect of low-molecular weight heparin in critically ill COVID-19 patients
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DOI：
10.1016/j.jcrc.2020.08.026
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发表时间：
2020-12-01
影响因子：
3.7
通讯作者：
Frithiof, R.
中科院分区：
文献类型：
--
作者：
Stattin, K.;Lipcsey, M.;Frithiof, R.
目的：探讨新冠肺炎危重患者凝血功能障碍的潜在标志物，以及低分子肝素（LMWH）预防血栓形成对血栓弹性成像（TEG）和抗Xa因子的影响。材料和方法：我们对31例连续的成人重症监护病房（ICU）患者进行了一项前瞻性研究。分别进行TEG（含和不含肝素酶）和抗Xa因子分析。标准的血栓预防给予达特帕林（75-100 IU/kg皮下注射）。结果：5例（16%）患者有症状性血栓栓塞事件。在ICU住院期间，所有患者的最大振幅（MA）均为65 mm， 13例（42%）的最大振幅（MA）为72 mm。23%的患者抗Xa因子活性低于目标范围，46%的患者高于目标范围。dalteparin剂量与抗Xa因子活性无显著相关性。结论：新型冠状病毒肺炎患者具有高凝性，TEG MA值高。低分子肝素对血栓栓塞性疾病、抗Xa因子活性和TEG的影响是可变的，不能可靠地预测。这表明低分子肝素的标准预防剂量可能不足。监测凝血和低分子肝素的作用对COVID-19患者很重要，但解释与血栓栓塞性疾病风险相关的结果存在困难。(C) 2020爱思唯尔公司版权所有。
Purpose: The aim of this study was to investigate potential markers of coagulopathy and the effects of thromboprophylaxis with low-molecular-weight heparin (LMWH) on thromboelastography (TEG) and anti-factor Xa in critically ill COVID-19 patients.Material and Methods: We conducted a prospective study in 31 consecutive adult intensive care unit (ICU) patients. TEG with and without heparinase and anti-factor Xa analysis were performed. Standard thromboprophylaxis was given with dalteparin (75-100 IU/kg subcutaneously).Results: Five patients (16%) had symptomatic thromboembolic events. All patients had a maximum amplitude (MA) > 65 mm and 13 (42%) had MA > 72 mm at some point during ICU stay. Anti-factor Xa activity were below the target range in 23% of the patients and above target range in 46% of patients. There was no significant correlation between dalteparin dose and anti-factor Xa activity.Conclusions: Patients with COVID-19 have hypercoagulability with high MA on TEG. The effect of LMWH on thromboembolic disease, anti-factor Xa activity and TEG was variable and could not be reliably predicted. This indicates that standard prophylactic doses of LMWH may be insufficient. Monitoring coagulation and the LMWH effect is important in patients with COVID-19 but interpreting the results in relation to risk of thromboembolic disease poses difficulties. (C) 2020 Elsevier Inc. All rights reserved.