Effect of Fluid Therapy on Coagulation in COVID-19 Patients in the Intensive Care Unit

ABSTRACT

Study Objectives: Several studies have evaluated CT pulmonary angiography of COVID-19 patients and reported a 7%-30% increase in the incidence of pulmonary embolism. In this study, it was aimed to investigate the effect of fluid therapy on coagulation in COVID-19 patients in the intensive care unit. Methods: This retrospective study included 120 patients hospitalized in the COVID-19 Intensive Care Unit for more than one week, between August 2020 and February 2021. Blood prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen, troponin, D-dimer levels, platelet count measured at the time of admission (T1, baseline) and one week after admission (T2), and the fluid treatments administered during this period were recorded. Patients were divided into the saline solution (SS) group (n=75), 0.45% saline solution group (0.45%, n=30), and combined fluid therapy group (SS+0.45%, n=15). Results: The change in PT was statistically significant for the SS group (p = 0.005), but not for the 0.45% and SS+0.45% groups (p = 0.625, p = 0.262, respectively). In the SS group, the aPTT levels increased posttreatment (p = 0.005). INR levels were significantly different between SS and SS+0.45% groups (p = 0.008). In the SS group, the INR levels increased between T1 and T2 (p = 0.014). In the SS group, the D-dimer levels significantly increased posttreatment. Conclusion: The D-dimer levels were prominent in the follow-up of the COVID-19 patients. Accordingly, using SS for fluid therapy may increase hypercoagulation and the risk of an embolism when compared to the SS, 0.45%, and combined (SS+0.45%) treatment.