PDF(Pubmed)
Abstract：
UNASSIGNED: Critically ill COVID-19 patients are at risk for venous thromboembolism (VTE). Therefore, they receive thromboprophylaxis and, when appropriate, therapeutic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). To monitor heparins in COVID-19 disease, whole-blood rotational thromboelastometry (ROTEM) may be a promising alternative to the aPTT and anti-Xa assays.
UNASSIGNED: To evaluate the ROTEM INTEM/HEPTEM ratios in mechanically ventilated COVID-19 patients treated with UFH and therapeutic LMWH.
UNASSIGNED: A subcohort of mechanically ventilated COVID-19 patients of the prospective Maastricht Intensive Care Covid (MaastrICCht) cohort was studied. Anti-Xa, aPTT, and ROTEM measurements following treatment with UFH or therapeutic dose of LMWH (nadroparin) were evaluated using uni- and multivariable linear regression analysis and receiver operating characteristics.
UNASSIGNED: A total of 98 patients were included, of which 82 were treated with UFH and 16 with therapeutic LMWH. ROTEM-measured INTEM/HEPTEM CT ratio was higher in patients using UFH (1.4 [1.3-1.4]) compared to patients treated with LMWH (1.0 [1.0-1.1], p < 0.001). Both the aPTT and anti-Xa were associated with the CT ratio. However, the β-regression coefficient (95%CI) was significantly higher in patients on UFH (0.31 (0.001-0.62)) compared to therapeutic LMWH (0.09 (0.05-0.13)) for comparison with the anti-Xa assay. Furthermore, ROC analysis demonstrated an area under the curve for detecting UFH of 0.936(0.849-1.00), 0.851(0.702-1.000), and 0.645(0.465-0.826) for the CT ratio, aPTT, and anti-Xa, respectively.
UNASSIGNED: The ROTEM INTEM/HEPTEM CT ratio appears a promising tool to guide anticoagulant therapy in ICU patients with COVID-19 disease, but associations with clinical endpoints are currently lacking.
UNASSIGNED: To evaluate the ROTEM INTEM/HEPTEM ratios in mechanically ventilated COVID-19 patients treated with UFH and therapeutic LMWH.
UNASSIGNED: A subcohort of mechanically ventilated COVID-19 patients of the prospective Maastricht Intensive Care Covid (MaastrICCht) cohort was studied. Anti-Xa, aPTT, and ROTEM measurements following treatment with UFH or therapeutic dose of LMWH (nadroparin) were evaluated using uni- and multivariable linear regression analysis and receiver operating characteristics.
UNASSIGNED: A total of 98 patients were included, of which 82 were treated with UFH and 16 with therapeutic LMWH. ROTEM-measured INTEM/HEPTEM CT ratio was higher in patients using UFH (1.4 [1.3-1.4]) compared to patients treated with LMWH (1.0 [1.0-1.1], p < 0.001). Both the aPTT and anti-Xa were associated with the CT ratio. However, the β-regression coefficient (95%CI) was significantly higher in patients on UFH (0.31 (0.001-0.62)) compared to therapeutic LMWH (0.09 (0.05-0.13)) for comparison with the anti-Xa assay. Furthermore, ROC analysis demonstrated an area under the curve for detecting UFH of 0.936(0.849-1.00), 0.851(0.702-1.000), and 0.645(0.465-0.826) for the CT ratio, aPTT, and anti-Xa, respectively.
UNASSIGNED: The ROTEM INTEM/HEPTEM CT ratio appears a promising tool to guide anticoagulant therapy in ICU patients with COVID-19 disease, but associations with clinical endpoints are currently lacking.
摘要：
■重症COVID-19患者有静脉血栓栓塞（VTE）的风险。因此,他们接受血栓预防，在适当的时候,治疗性普通肝素（UFH）或低分子量肝素（LMWH）。为了监测COVID-19疾病中的肝素，全血旋转血栓弹性测定法（ROTEM）可能是aPTT和抗Xa测定法的有希望的替代方法。
■评估接受UFH和治疗性LMWH治疗的机械通气COVID-19患者的ROTEMINTEM/HEPTEM比率。
■研究了前瞻性马斯特里赫特重症监护Covid（MaastrICCht）队列中机械通气的COVID-19患者的亚队列。Anti-Xa,aPTT,使用单变量和多变量线性回归分析和受试者工作特征评估UFH或治疗剂量LMWH(nadroparin)治疗后的ROTEM测量值。
■共包括98名患者，其中82例接受UFH治疗，16例接受治疗性LMWH治疗。使用UFH（1.4[1.3-1.4]）的患者与使用LMWH（1.0[1.0-1.1]，p<0.001)。aPTT和抗Xa均与CT比值相关。然而,与抗Xa分析相比,UFH患者的β回归系数(95CI)(0.31(0.001-0.62))显著高于治疗性LMWH(0.09(0.05-0.13)).此外，ROC分析显示检测UFH的曲线下面积为0.936（0.849-1.00），0.851(0.702-1.000),CT比率为0.645(0.465-0.826)，aPTT,和反Xa，分别。
■ROTEMINTEM/HEPTEMCT比值似乎是指导ICUCOVID-19患者抗凝治疗的有希望的工具，但目前缺乏与临床终点的关联.
■评估接受UFH和治疗性LMWH治疗的机械通气COVID-19患者的ROTEMINTEM/HEPTEM比率。
■研究了前瞻性马斯特里赫特重症监护Covid（MaastrICCht）队列中机械通气的COVID-19患者的亚队列。Anti-Xa,aPTT,使用单变量和多变量线性回归分析和受试者工作特征评估UFH或治疗剂量LMWH(nadroparin)治疗后的ROTEM测量值。
■共包括98名患者，其中82例接受UFH治疗，16例接受治疗性LMWH治疗。使用UFH（1.4[1.3-1.4]）的患者与使用LMWH（1.0[1.0-1.1]，p<0.001)。aPTT和抗Xa均与CT比值相关。然而,与抗Xa分析相比,UFH患者的β回归系数(95CI)(0.31(0.001-0.62))显著高于治疗性LMWH(0.09(0.05-0.13)).此外，ROC分析显示检测UFH的曲线下面积为0.936（0.849-1.00），0.851(0.702-1.000),CT比率为0.645(0.465-0.826)，aPTT,和反Xa，分别。
■ROTEMINTEM/HEPTEMCT比值似乎是指导ICUCOVID-19患者抗凝治疗的有希望的工具，但目前缺乏与临床终点的关联.
