目的:我们旨在分析范围以下的抗Xa活性与血栓栓塞事件之间的关系。
方法:单中心前瞻性观察性纵向队列研究(2021年2月至11月)。
方法:入住大学医院ICU的患者。
方法:重症肺炎COVID-19患者。
方法:依诺肝素用于预防性和治疗性抗凝。依诺肝素给药和剂量调整是根据医院方案基于抗Xa活性。
方法:目标:血栓栓塞事件。
方法:人口统计学,药物治疗,抗Xa测量,临床资料,和实验室结果。采用Logistic回归分析确定血栓栓塞事件的独立危险因素。
结果:数据可用于来自228名受试者的896种血清抗Xa测量。总的来说,71.9%为男性,平均年龄为62岁。大多数患者需要有创机械通气(87.7%),死亡率为24.1%。总共诊断出28.9%的新的血栓栓塞事件。有27.1%的抗Xa测量低于范围。当抗Xa活性低于范围(RR,4.2;p=0.000),C反应蛋白(25mg/L增加)(RR,1.14;p=0.005)和D-二聚体(增加1000ng/L)(RR,1.06;p=0.002)是与重症COVID-19患者新发血栓栓塞事件相关的独立因素。
结论:抗Xa活性低于范围,C反应蛋白和D-二聚体是重症COVID-19患者血栓栓塞事件的独立影响因素。应进行故意设计的临床试验,以确认抗Xa监测的益处。
OBJECTIVE: We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.
METHODS: Single center prospective observational longitudinal cohort study (February-November 2021).
METHODS: Patients admitted to the ICU of a University Hospital.
METHODS: Patients with severe COVID-19 pneumoniae.
METHODS: Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.
METHODS: Target: thomboembolic events.
METHODS: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results. Logistic regression was used to identify independent risk factors for thomboembolic events.
RESULTS: Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.
CONCLUSIONS: Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.