Better outcome with D-dimer guided anticoagulant in hospitalised patients with moderate and severe COVID-19 illness
| Autor: | M.-I Bolog, G Albu, E Pacuraru, A Rapa, M Marcvart, L Marzan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | European Heart Journal. 42 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehab724.2971 |
| Popis: | Background Venous thromboembolism (VTE) prophylaxis is recommended for all hospitalized COVID-19 patients in the absence of contraindications. Although D-dimer is a recognized biomarker for disease severity, there are insufficient data to recommend using this parameter to guide therapeutic decisions. Purpose The aim of the study is to investigate whether D-dimer guided anticoagulant therapy (ACT) is associated with a better evolution in moderate and severe COVID 19 illness. Methods We retrospectively analysed 120 consecutive patients (71 men, mean age 62.8±14 years old), hospitalised for moderate or severe COVID-19 illness. All patients were clinically examined, thoracic CT was performed, hematologic parameters were measured. Presence of VTE in patients with risk factors was excluded with doppler imaging and/or contrast thoracic CT. Patients with D-dimer ≤0.5 mg/L received prophylactic ACT (enoxaparin 40 mg daily), patients with D-dimer between 0.5 mg/L and 1 mg/L received 40 mg bid and those with D dimer ≥1mg/L were treated with full dose ACT (enoxaparin 1mg/kg bid). During hospitalization D-dimer was measured and the ACT was adapted accordingly. In all patients COVID-19 disease was managed according to current guidelines. After discharge patients were followed up 30±7 days. Prophylactic ACT was continued in patients with high thrombotic risk. Results 76 patients (63.3%) had moderate, and 44 patients (36.6%) had severe disease. Comorbidities were present in 71.5% patients (61.5% with cardiovascular disease, 16.6% with diabetes mellitus, 16.6% with obesity, 6.6% with renal failure, 4.1% with neoplastic disease). Average D-dimer was 1.3±0.8 mg/L. D-dimer elevation>0.5 mg/L was seen in 79 patients (65.8%). D-dimer was higher in patients with severe vs moderate illness 1.5±0.9 mg/L vs 1.01±0.9 mg/l (p Conclusions D-dimer guided therapy is associated with a lower incidence of TVP complications and mortality in moderate and severe hospitalized patients (0% vs 10% and 3.3% vs 20.3% respectively in literature data base) with nonsignificant haemorrhagic complications. This small observational study needs to be validated by further research. Funding Acknowledgement Type of funding sources: None. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|