Mora-Delgado Juan, Lojo-Cruz Cristina, Rubio Marín Patricia, Menor Campos Eva María, Michán-Doña Alfredo
Internal Medicine and Palliative Care Clinical Management Unit, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, 11407 Cádiz, Spain.
Departamento de Medicina, Biomedical Research and Innovation Institute of Cadiz (INiBICA), Avenida Ana de Viya, 21, 11009 Cádiz, Spain.
J Clin Med. 2023 Jan 25;12(3):928. doi: 10.3390/jcm12030928.
Some patients with COVID-19 have complex hypercoagulable abnormalities that are related to mortality. The optimal dosage of low molecular weight heparin in hospitalized patients with SARS-CoV-2 pneumonia is still not clear. Our objective is to evaluate the effects of adapting the dosage of low molecular weight heparin to thrombotic and bleeding risk scales in this setting. We performed a cohort, retrospective, observational, and analytical study at the Hospital Universitario of Jerez de la Frontera, with patients admitted with SARS-CoV-2 pneumonia from 1 October 2020 to 31 January 2021. They were classified according to whether they received prophylactic, intermediate, or therapeutic doses of enoxaparin. The primary endpoint was intrahospital mortality. Secondary endpoints were the need for invasive ventilation, thromboembolic events, bleeding, and the usefulness of thrombotic and bleeding scales. After binary logistic regression analysis, considering confounding variables, it was found that the use of enoxaparin at therapeutic doses was associated with lower mortality during admission compared to prophylactic and intermediate doses (RR 0.173; 95% CI, 0.038-0.8; = 0.025). IMPROVE bleeding risk score correlated with a higher risk of minor bleeding (RR 1.263; 95% CI, 1.105-1.573; = 0.037). In adult hospitalized patients with SARS-CoV-2 pneumonia presenting elevated D-dimer and severe proinflammatory state, therapeutic doses of enoxaparin can be considered, especially if bleeding risk is low according to the IMPROVE bleeding risk score.
一些新冠肺炎患者存在与死亡率相关的复杂高凝异常。住院的新型冠状病毒肺炎患者中低分子量肝素的最佳剂量仍不明确。我们的目的是评估在这种情况下根据血栓形成和出血风险量表调整低分子量肝素剂量的效果。我们在赫雷斯-德拉弗龙特拉大学医院进行了一项队列、回顾性、观察性和分析性研究，研究对象为2020年10月1日至2021年1月31日因新型冠状病毒肺炎入院的患者。根据他们接受的依诺肝素预防剂量、中等剂量或治疗剂量进行分类。主要终点是院内死亡率。次要终点是有创通气的需求、血栓栓塞事件、出血以及血栓形成和出血量表的实用性。在考虑混杂变量进行二元逻辑回归分析后，发现与预防剂量和中等剂量相比，治疗剂量的依诺肝素使用与入院期间较低的死亡率相关（相对风险0.173；95%置信区间，0.038 - 0.8；P = 0.025）。IMPROVE出血风险评分与轻微出血风险较高相关（相对风险1.263；95%置信区间，1.105 - 1.573；P = 0.037）。在D - 二聚体升高且存在严重促炎状态的成年住院新型冠状病毒肺炎患者中，可考虑使用治疗剂量的依诺肝素，尤其是根据IMPROVE出血风险评分出血风险较低时。
