Platelet Count Rose While D-Dimer Levels Dropped as Deaths and Thrombosis Declined-An Observational Study on Anticoagulation Shift in COVID-19
Platelet Count Rose While D-Dimer Levels Dropped as Deaths and Thrombosis Declined-An Observational Study on Anticoagulation Shift in COVID-19
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DOI：
10.1055/a-1477-3829
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发表时间：
2021-04-08
影响因子：
6.7
通讯作者：
Bruzelius, Maria
中科院分区：
文献类型：
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作者：
Sjostrom, Anna;Wersall, Johanna Dehlsen;Bruzelius, Maria
背景 高水平的 D-二聚体和低血小板计数与 2019 年冠状病毒病 (COVID-19) 的不良预后相关。由于抗凝治疗似乎可以提高生存率，因此于 2020 年 4 月 9 日在全院范围内实施了关于更高剂量抗凝治疗的建议。 目的 调查 D-二聚体水平和血小板计数的趋势是否与死亡、血栓形成和抗凝治疗的转变相关。 方法 对卡罗林斯卡大学医院 429 名 COVID-19 患者进行回顾性队列研究。 D-二聚体水平和血小板计数的信息来自实验室数据库和医疗记录的临床数据。结果 30 天死亡率和血栓形成率分别为 19% 和 18%。肺栓塞很常见，为 65/83 (78%)。住院第一周 D-二聚体水平升高与死亡和血栓形成显着相关（比值比 [OR]：6.06；95% 置信区间 [CL]：2.10-17.5 和 3.11；95% CI：1.20-8.10）。如果血小板计数每天增加超过35x10 (9) /L，死亡率和血栓形成风险就会降低（OR：0.16；95% CI：0.06-0.41，OR：0.36；95% CI：0.17-0.80）。在实施更新的全院建议后，D-二聚体水平的每日平均值显着下降，而血小板计数上升； -1.93； 95% CI：-1.00-2.87mg/L FEU（纤维蛋白原当量单位）和 65； 95% CI：54-76 x10 (9) /L，观察到死亡和血栓形成风险显着降低；或：0.48； 95% CI：0.25-0.92 和 0.35； 95% CI：0.17-0.72。 结论 与 D-二聚体水平相比，住院第一周血小板计数的增加与生存率的提高和血栓形成风险的降低相关。 D-二聚体的每日平均水平下降，而血小板计数上升，这与抗凝治疗的增加以及血栓负荷和死亡率的下降相一致。
Background High levels of D-dimer and low platelet counts are associated with poor outcome in coronavirus disease 2019 (COVID-19). As anticoagulation appeared to improve survival, hospital-wide recommendations regarding higher doses of anticoagulation were implemented on April 9, 2020.Objectives To investigate if trends in D-dimer levels and platelet counts were associated with death, thrombosis, and the shift in anticoagulation.Methods Retrospective cohort study of 429 patients with COVID-19 at Karolinska University Hospital. Information on D-dimer levels and platelet counts was obtained from laboratory databases and clinical data from medical records.Results Thirty-day mortality and thrombosis rates were 19% and 18%, respectively. Pulmonary embolism was common, 65/83 (78%). Increased D-dimer levels in the first week in hospital were significantly associated with death and thrombosis (odds ratio [OR]: 6.06; 95% confidence interval [CL]: 2.10-17.5 and 3.11; 95% CI: 1.20-8.10, respectively). If platelet count increased more than 35x10 (9) /L per day, the mortality and thrombotic risk decreased (OR: 0.16; 95% CI: 0.06-0.41, and OR: 0.36; 95% CI: 0.17-0.80). After implementation of updated hospital-wide recommendations, the daily mean significantly decreased regarding D-dimer levels while platelet counts rose; -1.93; 95% CI: -1.00-2.87mg/L FEU (fibrinogen-equivalent unit) and 65; 95% CI: 54-76 x10 (9) /L, and significant risk reductions for death and thrombosis were observed; OR: 0.48; 95% CI: 0.25-0.92 and 0.35; 95% CI: 0.17-0.72.Conclusion In contrast to D-dimer levels, increase of platelet count over the first week in hospital was associated with improved survival and reduced thrombotic risk. The daily mean levels of D-dimer dropped while the platelet counts rose, coinciding with increased anticoagulation and a decline in thrombotic burden and mortality.