Internal Medicine Department, University General Hospital of Patras, 265 04 Rio, Greece.
1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki "AXEPA", 546 21 Thessaloniki, Greece.
Viruses. 2022 Apr 7;14(4):767. doi: 10.3390/v14040767.
(1) Background: It is well-established that coronavirus disease-2019 (COVID-19) is highly pro-inflammatory, leading to activation of the coagulation cascade. COVID-19-induced hypercoagulability is associated with adverse outcomes and mortality. Current guidelines recommend that hospitalized COVID-19 patients should receive pharmacological prophylaxis against venous thromboembolism (VTE). (2) INTERACT is a retrospective, phase IV, observational cohort study aiming to evaluate the overall clinical effectiveness and safety of a higher than conventionally used prophylactic dose of anticoagulation with tinzaparin administered for VTE prevention in non-critically ill COVID-19 patients with moderate disease severity. (3) Results: A total of 705 patients from 13 hospitals in Greece participated in the study (55% men, median age 62 years). Anticoagulation with tinzaparin was initiated immediately after admission. A full therapeutic dose was received by 36.3% of the participants (mean ± SD 166 ± 33 IU/Kgr/day) and the remaining patients (63.9%) received an intermediate dose (mean ± SD 114 ± 22 IU/Kgr/day). The median treatment duration was 13 days (Q1−Q3: 8−20 days). During the study (April 2020 to November 2021), 14 thrombotic events (2.0%) were diagnosed (i.e., three cases of pulmonary embolism (PE) and 11 cases of deep venous thrombosis, DVT). Four bleeding events were recorded (0.6%). In-hospital death occurred in 12 patients (1.7%). Thrombosis was associated with increasing age (median: 74.5 years, Q1−Q3: 62−79, for patients with thrombosis vs. 61.9 years, Q1−Q3: 49−72, p = 0.0149), increased D-dimer levels for all three evaluation time points (at admission: 2490, Q1−Q3: 1580−6480 vs. 700, Q1−Q3: 400−1475, p < 0.0001), one week ± two days after admission (3510, Q1−Q3: 1458−9500 vs. 619, Q1−Q3: 352−1054.5, p < 0.0001), as well as upon discharge (1618.5, Q1−Q3: 1010−2255 vs. 500, Q1−Q3: 294−918, p < 0.0001). Clinical and laboratory improvement was affirmed by decreasing D-dimer and CRP levels, increasing platelet numbers and oxygen saturation measurements, and a drop in the World Health Organization (WHO) progression scale. (4) Conclusions: The findings of our study are in favor of prophylactic anticoagulation with an intermediate to full therapeutic dose of tinzaparin among non-critically ill patients hospitalized with COVID-19.
(1)背景:众所周知,2019 年冠状病毒病(COVID-19)高度促炎,导致凝血级联激活。COVID-19 引起的高凝状态与不良结局和死亡率有关。目前的指南建议住院的 COVID-19 患者应接受预防静脉血栓栓塞(VTE)的药物预防。(2)INTERACT 是一项回顾性、四期、观察性队列研究,旨在评估在中度疾病严重程度的非危重症 COVID-19 患者中,使用高于常规预防剂量的替扎肝素进行抗凝预防 VTE 的总体临床疗效和安全性。(3)结果:来自希腊 13 家医院的 705 名患者参与了这项研究(55%为男性,中位年龄 62 岁)。替扎肝素抗凝在入院后立即开始。36.3%的参与者(平均 ± 标准差 166 ± 33 IU/Kgr/天)接受了全治疗剂量,其余患者(63.9%)接受了中等剂量(平均 ± 标准差 114 ± 22 IU/Kgr/天)。中位治疗持续时间为 13 天(Q1-Q3:8-20 天)。在研究期间(2020 年 4 月至 2021 年 11 月),诊断出 14 例血栓事件(2.0%)(即,3 例肺栓塞(PE)和 11 例深静脉血栓形成,DVT)。记录了 4 例出血事件(0.6%)。12 名患者住院期间死亡(1.7%)。血栓与年龄增长有关(中位数:74.5 岁,Q1-Q3:62-79,与血栓患者相比,61.9 岁,Q1-Q3:49-72,p = 0.0149),所有三个评估时间点的 D-二聚体水平升高(入院时:2490,Q1-Q3:1580-6480 与 700,Q1-Q3:400-1475,p < 0.0001),入院后一周±两天(3510,Q1-Q3:1458-9500 与 619,Q1-Q3:352-1054.5,p < 0.0001),以及出院时(1618.5,Q1-Q3:1010-2255 与 500,Q1-Q3:294-918,p < 0.0001)。D-二聚体和 CRP 水平的降低、血小板数量和氧饱和度测量值的增加以及世界卫生组织(WHO)进展量表的下降证实了临床和实验室的改善。(4)结论:我们的研究结果支持对住院的 COVID-19 非危重症患者使用中等至全治疗剂量的替扎肝素进行预防性抗凝治疗。