Medicina intensiva · 2024
Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Marcos-Neira Pilar, Morales-Indiano Cristian, Fernández-Caballero Mariana, Tomasa-Irriguible Teresa, Bordejé-Laguna Luisa, Ruíz-Artola Víctor
Аннотация
OBJECTIVE: We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.
DESIGN: Single center prospective observational longitudinal cohort study (February-November 2021).
SETTING: Patients admitted to the ICU of a University Hospital.
PARTICIPANTS: Patients with severe COVID-19 pneumoniae.
INTERVENTIONS: Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.
MAIN VARIABLES OF INTEREST: Target: thomboembolic events.
PREDICTORS: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results. Logistic regression was used to identify independent risk factors for thomboembolic events.
RESULTS: Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.
CONCLUSIONS: Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.
DESIGN: Single center prospective observational longitudinal cohort study (February-November 2021).
SETTING: Patients admitted to the ICU of a University Hospital.
PARTICIPANTS: Patients with severe COVID-19 pneumoniae.
INTERVENTIONS: Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.
MAIN VARIABLES OF INTEREST: Target: thomboembolic events.
PREDICTORS: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results. Logistic regression was used to identify independent risk factors for thomboembolic events.
RESULTS: Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.
CONCLUSIONS: Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.