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Thrombotic events following tocilizumab therapy in critically ill COVID-19 patients: a Façade for prognostic markers.
Atallah, Bassam; El Nekidy, Wasim; Mallah, Saad I; Cherfan, Antoine; AbdelWareth, Laila; Mallat, Jihad; Hamed, Fadi.
  • Atallah B; Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.
  • El Nekidy W; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA.
  • Mallah SI; Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.
  • Cherfan A; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA.
  • AbdelWareth L; School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Al Sayh, Bahrain.
  • Mallat J; Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.
  • Hamed F; Department of Clinical Pathology, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.
Thromb J ; 18: 22, 2020.
Article in English | MEDLINE | ID: covidwho-1793931
ABSTRACT

BACKGROUND:

Hospitals in the Middle East Gulf region have experienced an influx of COVID-19 patients to their medical wards and intensive care units. The hypercoagulability of these patients has been widely reported on a global scale. However, many of the experimental treatments used to manage the various complications of COVID-19 have not been widely studied in this context. The effect of the current treatment protocols on patients' diagnostic and prognostic biomarkers may thus impact the validity of the algorithms adopted. CASE PRESENTATION In this case series, we report four cases of venous thromboembolism and 1 case of arterial thrombotic event, in patients treated with standard or intensified prophylactic doses of unfractionated heparin or low molecular weight heparin at our institution. Tocilizumab has been utilized as an add-on therapy to the standard of care to treat patients with SARS-CoV-2 associated acute respiratory distress syndrome, in order to dampen the hyperinflammatory response. It is imperative to be aware that this drug may be masking the inflammatory markers (e.g. IL6, CRP, fibrinogen, and ferritin), without reducing the risk of thrombotic events in this population, creating instead a façade of an improved prognostic outcome. However, the D-dimer levels remained prognostically reliable in these cases, as they were not affected by the drug and continued to be at the highest level until event occurrence.

CONCLUSIONS:

In the setting of tocilizumab therapy, traditional prognostic markers of worsening infection and inflammation, and thus potential risk of acute thrombosis, should be weighed carefully as they may not be reliable for prognosis and may create a façade of an improved prognostic outcome insteasd. Additionally, the fact that thrombotic events continued to be observed despite decrease in inflammatory markers and the proactive anticoagulative approach adopted, raises more questions about the coagulative mechanisms at play in COVID-19, and the appropriate management strategy.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Thromb J Year: 2020 Document Type: Article Affiliation country: S12959-020-00236-9

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Thromb J Year: 2020 Document Type: Article Affiliation country: S12959-020-00236-9