一项关于重症新型冠状病毒肺炎患者抗Xa因子值与死亡、血栓栓塞及出血之间关联的回顾性多中心队列研究。
A retrospective multicenter cohort study of the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19.
作者信息
Jonmarker Sandra, Litorell Jacob, Alarcon Felix, Al-Abani Kais, Björkman Sofia, Farm Maria, Grip Jonathan, Söderberg Mårten, Hollenberg Jacob, Wahlin Rebecka Rubenson, Kander Thomas, Rimling Liivi, Mårtensson Johan, Joelsson-Alm Eva, Dahlberg Martin, Cronhjort Maria
机构信息
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden.
出版信息
Thromb J. 2023 Oct 2;21(1):101. doi: 10.1186/s12959-023-00541-z.
BACKGROUND
Patients with critical COVID-19 have a high risk of thromboembolism, but intensified thromboprophylaxis has not been proven beneficial. The activity of low-molecular-weight heparins can be monitored by measuring anti-Factor Xa. We aimed to study the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19.
METHOD
This retrospective cohort study included adult patients with critical COVID-19 admitted to an intensive care unit at three Swedish hospitals between March 2020 and May 2021 with at least one valid peak and/or trough anti-Factor Xa value. Within the peak and trough categories, patients' minimum, median, and maximum values were determined. Logistic regressions with splines were used to assess associations.
RESULTS
In total, 408 patients had at least one valid peak and/or trough anti-Factor Xa measurement, resulting in 153 patients with peak values and 300 patients with trough values. Lower peak values were associated with thromboembolism for patients' minimum (p = 0.01), median (p = 0.005) and maximum (p = 0.001) values. No association was seen between peak values and death or bleeding. Higher trough values were associated with death for median (p = 0.03) and maximum (p = 0.002) values and with both bleeding (p = 0.01) and major bleeding (p = 0.02) for maximum values, but there were no associations with thromboembolism.
CONCLUSIONS
Measuring anti-Factor Xa activity may be relevant for administrating low-molecular-weight heparin to patients with critical COVID-19. Lower peak values were associated with an increased risk of thromboembolism, and higher trough values were associated with an increased risk of death and bleeding. Prospective studies are needed to confirm the results.
TRIAL REGISTRATION
The study was retrospectively registered at Clinicaltrials.gov, NCT05256524, February 24, 2022.
背景
重症新型冠状病毒肺炎（COVID-19）患者有较高的血栓栓塞风险，但强化血栓预防的益处尚未得到证实。低分子肝素的活性可通过测定抗Xa因子来监测。我们旨在研究抗Xa因子值与重症COVID-19患者死亡、血栓栓塞和出血之间的关联。
方法
这项回顾性队列研究纳入了2020年3月至2021年5月期间在瑞典三家医院的重症监护病房住院的成年重症COVID-19患者，这些患者至少有一个有效的抗Xa因子峰值和/或谷值。在峰值和谷值类别中，确定患者的最小值、中位数和最大值。使用带样条的逻辑回归来评估关联。
结果
共有408例患者至少有一次有效的抗Xa因子峰值和/或谷值测量，其中153例患者有峰值测量值，300例患者有谷值测量值。较低的峰值与患者最小值（p = 0.01）、中位数（p = 0.005）和最大值（p = 0.001）时的血栓栓塞相关。峰值与死亡或出血之间未发现关联。较高的谷值与中位数（p = 0.03）和最大值（p = 0.002）时的死亡相关，与最大值时的出血（p = 0.01）和大出血（p = 0.02）相关，但与血栓栓塞无关。
结论
测定抗Xa因子活性可能与对重症COVID-19患者应用低分子肝素有关。较低的峰值与血栓栓塞风险增加相关，较高的谷值与死亡和出血风险增加相关。需要进行前瞻性研究来证实这些结果。
试验注册
该研究于2022年2月24日在Clinicaltrials.gov上进行回顾性注册，注册号为NCT05256524。
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