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Low-Molecular-Weight Heparin Resistance and Its Viscoelastic Assessment in Critically Ill COVID-19 Patients.
Bösch, Johannes; Rugg, Christopher; Schäfer, Volker; Lichtenberger, Philipp; Staier, Nikolai; Treichl, Benjamin; Rajsic, Sasa; Peer, Andreas; Schobersberger, Wolfgang; Fries, Dietmar; Bachler, Mirjam.
  • Bösch J; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Rugg C; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Schäfer V; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Lichtenberger P; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Staier N; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Treichl B; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Rajsic S; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Peer A; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria.
  • Schobersberger W; Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT - Private University for Health Sciences and Health Technology, Hall i.T., Austria.
  • Fries D; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Bachler M; Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
Semin Thromb Hemost ; 48(7): 850-857, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2050627
ABSTRACT
Critically ill COVID-19 patients present an inflammatory and procoagulant status with a high rate of relevant macro- and microvascular thrombosis. Furthermore, high rates of heparin resistance have been described; yet, individualized anticoagulation by drug monitoring has not been sufficiently researched. We analyzed data from critically ill COVID-19 patients treated at Innsbruck Medical University Hospital with routinely adapted low-molecular-weight heparin (LMWH) doses according to anti-Xa peak levels, and regularly performed ClotPro analyses (a viscoelastic hemostatic whole blood test). A total of 509 anti-Xa peak measurements in 91 patients were categorized as below (<0.008 IU/mL/mg), within (0.008-0-012 IU/mL/mg) or above (> 0.012 IU/mL/mg) expected ranges with respect to the administered LMWH doses. Besides intergroup comparisons, correlations between anti-Xa levels and ClotPro clotting times (CTs) were performed (226 time points in 84 patients). Anti-Xa peak levels remained below the expected range in the majority of performed measurements (63.7%). Corresponding patients presented with higher C-reactive protein and D-dimer but lower antithrombin levels when compared with patients achieving or exceeding the expected range. Consequently, higher enoxaparin doses were applied in the sub-expected anti-Xa range group. Importantly, 47 (51.6%) patients switched between groups during their intensive care unit (ICU) stay. Anti-Xa levels correlated weakly with IN test CT and moderately with Russell's viper venom (RVV) test CT. Critically ill COVID-19 patients present with a high rate of LMWH resistance but with a variable LMWH response during their ICU stay. Therefore, LMWH-anti-Xa monitoring seems inevitable to achieve adequate target ranges. Furthermore, we propose the use of ClotPro's RVV test to assess the coagulation status during LMWH administration, as it correlates well with anti-Xa levels but more holistically reflects the coagulation cascade than anti-Xa activity alone.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hemostatics / COVID-19 Drug Treatment Type of study: Experimental Studies / Randomized controlled trials Limits: Humans Language: English Journal: Semin Thromb Hemost Year: 2022 Document Type: Article Affiliation country: S-0042-1756304

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hemostatics / COVID-19 Drug Treatment Type of study: Experimental Studies / Randomized controlled trials Limits: Humans Language: English Journal: Semin Thromb Hemost Year: 2022 Document Type: Article Affiliation country: S-0042-1756304