D-dimer elevation and anticoagulation therapy in COVID-19 patients

ABSTRACT

Background: In approximately 30% of COVID-19 cases, the hospitalized patients are developing venous thrombo-embolic complications, due to imune-mediated hypercoagulable responce and inadequate thromboprophylaxis. D-dimer elevattion can be seen in severe critically ill COVID-19 patients. and those with other medical conditions associated with increased thrombotic risk. Aims: The aim of the study was to analyse the fibrinolytic activity, and to monitor the anticoagulation therapy in the hospitalized COVID-19 patients at the Clinic for Infectious Diseases and Febrile States in Skopje. Methods: In a retrospective study, 1728 patients with COVID -19 infection hospitalized at the Clinic for Infectious Diseases and Febrile States with COVID-19 from March-September 2020 were analized. The D-dimers level was measured with the coagulometer Dade Behring BCS XP-Siemens with commercial reagents from Siemens. The anti-factor Xa level was measured with chromogenic anti-Xa assay. Results: Analized data from 1728 hospitalized patients showed increased level of D-dimers. The average level was 1974 ng/ml (0- 500 ng/ml). Peak D-dimer levels were seen in some patients during the hospitalization period (>35,000 ng/ml). Patients received anticoagulation therapy with low-molecular heparin. The anti-factor Xa assay was analized in nine patients, three of them were in the prophylactic range (0.2-0.5 IE), and 6 were in the therapeutic range (0.5-1.2 IE). Summary/Conclusions: Increased D-dimers in hospitalized patients with severe COVID-19 are common laboratory findings, and the are prognostic marker for in-hospital mortality. Prolonged immobility and other risk factors for VTE in those patients may lead to thrombotic complications. The dosage regimen of low molecular weight heparin must be evaluated in every patient, especially in patients with severe renal impairment, low platelet count and weight disproportions, in order for appropritate anticoagulation and avoiding the associated bleeding risk.