Anticoagulant treatment and COVID-19

Year 2022, Volume: 9 Issue: 1, 106 - 111, 31.03.2022

İbrahim Halil Özdemır , Mehmet Burak Özen , Ramazan Gündüz

https://doi.org/10.34087/cbusbed.1007918

Cited By: 1

Abstract

Objective: In this study, we aimed to examine the effect of atrial fibrillation (AF) on mortality in COVID-19 patients and the risk scores that can be used in determining risky AF patients. In addition, we aimed to examine the place of oral anticoagulant use in treatment.
Materials and Methods: Records of patients diagnosed with COVID-19 were retrospectively reviewed. Among these patients, 48 patients with a diagnosis of AF were identified. Intensive care need, mortality, CHA2DS2VASC and HAS-BLED scores of the patients were recorded. CRP and D-Dimer levels were recorded. Oral anticoagulant treatments used by the patients were recorded.
Results: The CHA2DS2VASC (intensive care: 4,50±1,41, internal medicine service: 2,50±1,05, p<0,05) and HAS-BLED (intensive care: 2,0±1,08, internal medicine service: 1,5±0,77, p<0,05) scores of the patients followed in the intensive care unit were higher. Non-Survivor Patients with atrial fibrillation had higher CRP (survivor: 21,50±15,23, non-survivor: 142,30±48,49, p<0,05) and D-Dimer (survivor: 183,47±43,68, non-survivor: 878,98±112,24, p<0,05) values. While 24 of the patients continued their oral anticoagulant use, 24 of them used low molecular weight heparin (LMWH). No bleeding was detected in any of these patients. Anemia requiring erythrocyte replacement was similarbetween the two groups (oral anticoagulant: 2 (8,3%), LMWH: 3 (12,5%), p:0,152). Mortality was similar between both groups (oral anticoagulant: 5 (20,8%), LMWH: 5 (20,8%), p: 0,248).
Conclusion: AF is an important cardiovascular risk factor affecting mortality in COVID-19. CHA2DS2VASC and HAS-BLED scores are important in determining patients at risk. CRP and D-Dimer are important laboratory parameters in determining risky AF patients. Anticoagulant treatments used by patients can be considered instead of LMWH recommended in the treatment of COVID-19.

Keywords

Atrial Fibrillation, COVID-19, CHA2DS2VASC, HAS-BLED, anticoagulant treatment

Supporting Institution

yok

Project Number

yok

Thanks

Dear Editor, Please find attached our manuscript for publication in Celal Bayar Sağlık Bilimleri Enstitüsü Dergisi entitled: Anticoagulant treatment and COVID-19 Article category preference: Original Article The work described here has not been published before; it is not under consideration for publication anywhere else and its publication has been approved by all co-authors. In case of any questions please do not hesitate to contact us anytime. Funding: None Conflict of interest for all authors: None All authors had access to the data and a role in writing the manuscript Address for correspondence İbrahim Halil Özdemir Manisa City Hospital, Department of Cardiology Adnan Menderes Mh. 132.Sokak No : 15 45040 Şehzadeler, Manisa E-mail: [e-mail]

Antikoagülan Tedavi ve COVID-19

Abstract

Giriş ve Amaç: Bu çalışmada, atriyal fibrilasyonun (AF) COVID-19 hastalarında mortaliteye etkisini ve riskli AF hastalarının belirlenmesinde kullanılabilicek risk skorlarını incelemeyi amaçladık. Bunun yanında oral antikoagülan kullanımın tedavideki yerini incelemeyi amaçladık.
Gereç ve Yöntemler: COVID-19 tanısı almış hastaların kayıtları retrospektif olarak incelendi. Bu hastalar içinden AF tanısı olan 48 hasta belirlendi. Hastaların yoğun bakım ihtiyacı, mortalitesi, CHA2DS2VASC ve HAS-BLED skorları kaydedildi. CRP ve D-Dimer düzeyleri kaydedildi. Hastaların kullanmış oldukları oral antikoagülan tedaviler kayıt altına alındı.
Bulgular: Yoğun bakım ünitesinde takip edilen hastaların CHA2DS2VASC (yoğun bakım: 4,50±1,41, dahiliye servisi: 2,50±1,05, p<0,05) ve HAS-BLED (yoğun bakım: 2,0±1,08, dahiliye servisi: 1,5±0,77, p<0,05) skorları daha yüksekti. Hayatını kaybeden atriyal fibrilasyonlu hastalar daha yüksek CRP (hayatta kalan: 21,50 ± 15,23, hayatta kalmayan: 142,30 ± 48,49, p <0,05) ve D-Dimer (hayatta kalan: 183,47 ± 43,68, hayatta kalmayan: 878,98 ± 112,24, p <0,05) değerlerine sahipti. Hastaların 24’ü kullanmış olduğu oral antikoagülana devam ederken 24’ü düşük molekül ağrlıklı heparin (DMAH) kullanmış. Bu hastaların hiçbirinde kanama saptanmadı. Eritrosit replasmanı gerektiren anemi iki grup arasında benzerdi (oral antikoaülan: 2 (8,3%), DMAH: 3 (12,5%), p:0,152). Mortalite her iki grup arasında benzerdi (oral antikoaülan: 5 (20,8%), DMAH: 5 (20,8%), p:0,248).
Sonuç: AF, COVID-19'da mortaliteyi etkileyen önemli bir kardiyovasküler risk faktörüdür. Riskli hastaların belirlenmesinde CHA2DS2VASC ve HAS-BLED skorları önemlidir. CRP ve D-Dimer, riskli AF hastalarının belirlenmesinde önemli laboratuvar parametreleridir. Hastaların kullanmış oldukları antikoagülan tedaviler COVID-19 tedavisinde önerilen DMAH yerine düşünülebilir.

Keywords

Atriyal fibrilasyon, COVID-19, CHA2DS2VASC, HAS-BLED, antikoagülan tedavi

Project Number

yok

References

• Chen, L, Liu, W, Zhang, Q, et al., RNA based mNGS approach identifies a novel human coronavirus from two individual pneumonia cases in 2019 Wuhan outbreak, Emerging microbes & infections, 2020, 9(1), 313-319.
• Zhu, N, Zhang, D, Wang, W, et al., A Novel Coronavirus from Patients with Pneumonia in China, 2019, The New England journal of medicine, 2020, 382(8), 727-733.
• Mahase, E, Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction, BMJ (Clinical research ed), 2020, 368, m1036.
• Wang, D, Hu, B, Hu, C, et al., Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China, JAMA, 323(11), 1061–1069.
• Huang, C, Wang, Y, Li, X, et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet, 2020, 395(10223), 497-506.
• Inciardi, R.M, Adamo, M, Lupi, L, et al., Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy, European heart journal, 2020, 41(19), 1821-1829.
• Fumagalli, S, Salani, B, Gabbani, L, Mossello, E, Ungar, A, Covid-19 cases in a no-Covid-19 geriatric acute care setting, A sporadic occurrence? European journal of internal medicine, 2020, 77, 141-142.
• Barón-Esquivias, G, Manito, N, López Díaz, J, et al., Update for 2014 on clinical cardiology, geriatric cardiology, and heart failure and transplantation, Revista espanola de cardiologia (English ed), 2015, 68(4), 317-323.
• January, C.T, Wann, L.S, Alpert, J.S, et al., American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society, Journal of American College of Cardiology, 2014, 64(21), e1-76.
• Chen, L.Y, Sotoodehnia, N, Bůžková, P, et al., Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study, JAMA internal medicine, 2013, 173(1), 29-35.
• Chen, N, Zhou, M, Dong, X, et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Lancet, 2020, 395(10223), 507-513.
• Tang, N, Li, D, Wang, X, et al., Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia, Journal of Thrombosis Haemostasis, 2020, 18(4), 844-847.
• Shanghai Clinical Treatment Expert Group for Corona Virus Disease 2019, Comprehensive treatment and management of corona virus disease 2019: expert consensus statement from Shanghai [J], Chinese Journal of Infectious Diseases, 2020, 38 (00), E016-E016.
• Thachil, J, Tang, N, Gando, S, et al., ISTH interim guidance on recognition and management of coagulopathy in COVID-19, Journal of thrombosis and haemostasis : JTH, 2020, 18(5), 1023-1026.
• Sünmez, S, Okumuş, G, Kiyan, E, Ece, T, Arseven, O, [A case of heparin induced thrombocytopenia treated with lepirudin infusion: case report], Tuberkuloz ve toraks, 2006, 54(2), 185-188.
• Thachil, J, Tang, N, Gando, S, et al., DOACs and "newer" hemophilia therapies in COVID-19: Reply, Journal of thrombosis and haemostasis, 2020, 18(7), 1795-1796.
• Testa, S, Paoletti, O, Giorgi-Pierfranceschi, M, Pan, A, Switch from oral anticoagulants to parenteral heparin in SARS-CoV-2 hospitalized patients, Internal and emergency medicine, 2020, 15(5), 751-753.
• Zhang, L, Yan, X, Fan, Q, et al., D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19, Journal of thrombosis and haemostasis : JTH. 2020, 18(6), 1324-1329.
• Horby, P, Lim, W.S, Emberson, J.R, et al., Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report, The New England journal of medicine, 2020.