Gabarre Paul, Urbina Tomas, Cunat Sibylle, Merdji Hamid, Bonny Vincent, Lavillegrand Jean-Rémi, Raia Lisa, Bige Naïke, Baudel Jean-Luc, Maury Eric, Guidet Bertrand, Helms Julie, Ait-Oufella Hafid
Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France.
Sorbonne University, Paris, France.
Minerva Anestesiol. 2023 Jan-Feb;89(1-2):48-55. doi: 10.23736/S0375-9393.22.16640-X. Epub 2022 Oct 25.
Several studies have reported an increased risk of thrombotic events in COVID-19 patients, but the pathophysiology of this procoagulant phenotype remains poorly understood. We hypothesized that corticosteroids may attenuate this procoagulant state through their anti-inflammatory effects. The aim of this study was to evaluate the impact of dexamethasone (DXM) on the coagulation profile of severely ill COVID-19 patients.
We conducted a retrospective, observational before/after bi-centric cohort study among ICU patients hospitalized for severe COVID-19 and receiving therapeutic anticoagulation by unfractionated heparin (UFH). Before and after the standardized use of DXM, we compared inflammatory and coagulation profiles, as well as the kinetics of heparin requirement, adjusted for weight and anti-Xa activity.
Eighty-six patients were included, 35 in the no-DXM group, and 51 in the DXM group. At admission, CRP and fibrinogen levels were not different between groups, neither were UFH infusion rates. At day 3 after ICU admission, CRP (178±94 mg/L vs. 99±68 mg/L, P<0.001) and fibrinogen (7.2±1.4 g/L vs. 6.1±1.4 g/L, P=0.001) significantly decreased in the DXM group, but not in the no-DXM group. Over time, UFH infusion rates were lower in the DXM group (P<0.001) without any significant difference in plasma anti-Xa activity. CRP variations correlated with heparin dose variations between Day 0 and Day 3 (r=0.39, P=0.009). Finally, the incidence of venous thromboembolic events during in-ICU stay was significantly reduced in the DXM group (4 vs. 43%, P<0.0001).
In critically ill COVID-19 patients, dexamethasone use was associated with a decrease in both pro-inflammatory and procoagulant profile.
多项研究报告称，新冠病毒病（COVID-19）患者发生血栓事件的风险增加，但这种促凝表型的病理生理学仍知之甚少。我们推测，皮质类固醇可能通过其抗炎作用减轻这种促凝状态。本研究的目的是评估地塞米松（DXM）对重症COVID-19患者凝血指标的影响。
我们在因重症COVID-19住院并接受普通肝素（UFH）治疗性抗凝的ICU患者中进行了一项回顾性、双中心前后队列研究。在标准化使用DXM之前和之后，我们比较了炎症和凝血指标，以及根据体重和抗Xa活性调整后的肝素需求量变化。
共纳入86例患者，其中无DXM组35例，DXM组51例。入院时，两组的CRP和纤维蛋白原水平无差异，UFH输注率也无差异。在ICU入院后第3天，DXM组的CRP（178±94mg/L对99±68mg/L，P<0.001）和纤维蛋白原（7.2±1.4g/L对6.1±1.4g/L，P=0.001）显著下降，而无DXM组则未下降。随着时间的推移，DXM组的UFH输注率较低（P<0.001），血浆抗Xa活性无显著差异。CRP变化与第0天至第3天的肝素剂量变化相关（r=0.39，P=0.009）。最后，DXM组在ICU住院期间静脉血栓栓塞事件的发生率显著降低（4%对43%，P<0.0001）。
在重症COVID-19患者中，使用地塞米松与促炎和促凝指标的降低有关。
