Safety and Efficacy of Apixaban For Therapeutic Anticoagulation in Critically Ill ICU Patients with Severe COVID-19 Respiratory Disease.
Safety and Efficacy of Apixaban For Therapeutic Anticoagulation in Critically Ill ICU Patients with Severe COVID-19 Respiratory Disease.
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DOI：
10.1055/s-0040-1720962
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Benken ST
中科院分区：
文献类型：
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作者：
Wenzler E;Engineer MH;Yaqoob M;Benken ST
尽管使用未分离肝素（UFH）或低分子量肝素（LMWH），但在2019年严重新型冠状病毒病（COVID-19）患者中，血栓栓塞性疾病的发生率以及随后的发病率和死亡率仍然高得令人无法接受。直接口服抗凝剂（doac），如阿哌沙班，具有许多据称的益处，尽管其在重症监护病房（ICU）重症COVID-19患者中的安全性和有效性尚未得到评估。材料与方法对21例重症COVID-19呼吸系统疾病患者进行单中心、回顾性队列研究，采用阿哌沙班治疗房颤（AFib）、静脉血栓栓塞（VTE）、导管血栓形成和/或COVID-19诱导的凝血功能障碍。主要目的是评估出血事件的发生率，次要目的包括血栓栓塞事件、凝血参数和死亡率。结果90%的患者非white， 43%的患者肥胖，90%的患者有急性呼吸窘迫综合征，76%的患者需要机械通气。近一半（47.6%）的患者也出现肾功能障碍，需要肾脏替代治疗。86%的患者在阿哌沙班开始前的24小时内接受了UFH或低分子肝素的预防或治疗。患者开始使用阿哌沙班治疗疑似或确诊的静脉血栓栓塞（67%）或AFib（33%）。在10天的监测期间，所有凝血参数均异常但稳定。在整个研究期间，没有患者发生任何大出血事件或血栓形成。随访期间有4例死亡，均被认为与凝血病或出血无关。结论阿哌沙班治疗重症COVID-19患者安全有效。这些数据鼓励未来的试验寻求优化严重COVID-19患者的抗凝策略。
Introduction Despite the use of unfractionated heparin (UFH) or low molecular weight heparin (LMWH), rates of thromboembolic disease, and subsequent morbidity and mortality remain unacceptably high in patients with severe novel coronavirus disease 2019 (COVID-19) disease. Direct oral anticoagulants (DOACs), such as apixaban, have numerous purported benefits although the safety and efficacy of their use in intensive care unit (ICU) patients with severe COVID-19 has yet to be evaluated. Materials and Methods Single-center, retrospective cohort study of 21 ICU patients with severe COVID-19 respiratory disease treated with apixaban for atrial fibrillation (AFib), venous thromboembolism (VTE), catheter-induced thrombosis, and/or COVID-19-induced coagulopathy. The primary objective was to evaluate the incidence of bleeding events and secondary objectives included thromboembolic events, coagulation parameters, and mortality. Results Ninety percent of patients were non-White, 43% were obese, 90% had acute respiratory distress syndrome, and 76% required mechanical ventilation. Nearly half of (47.6%) also experienced renal dysfunction and required renal replacement therapy. Eighty-six percent of patients received prophylaxis or treatment with UFH or LMWH within the 24-hour period prior to apixaban initiation. Patients were initiated on apixaban for the treatment of suspected or confirmed VTE (67%) or AFib (33%). All coagulation parameters remained abnormal but stable throughout the 10-day monitoring period. No patients experienced any major bleeding events or thrombosis throughout the study period. There were four deaths during the follow-up period, all deemed unrelated to coagulopathy or bleeding. Conclusion Apixaban appeared safe and efficacious in ICU patients with severe COVID-19 disease. These data encourage future trials seeking to optimize anticoagulation strategies in patients with severe COVID-19.