GKD Anest Yoð Bak Dern Derg. 2021; 27(2): 171-174 | DOI: 10.5222/GKDAD.2021.48343

Effects of Differences in Doses of Low-Molecular Weight Heparin in Severe COVID-19 Patients

Mine Altýnkaya Çavuþ, Hafize Sav
Kayseri City Hospital

Objective: The most prominent clinical finding in severe COVID-19 patients is endothelial damage. For these reasons, active administration of anticoagulants (such as heparin) is recommended to patients with severe COVID-19. The purpose of this study is to investigate the effects of different doses of low-molecular weight heparin (LMWH) on severe COVID-19 patients.
Methods: This study was performed retrospectively in intensive care unit of a tertiary referral hospital. PCR (polymerase chain reaction) positive (+) patients were included in the study. Patients’ demographic data, length of stay in the hospital and intensive care unit, laboratory values (D-dimer, CRP, creatinine) on the last day of intensive care stay, mortality and invasive mechanical ventilator needs were recorded. Group O: consisted of patients not receiving anticoagulants, and Group 1 received a single daily dose of 40 mg enoxaparin sodium (equivalent to 4000 anti-Xa IU), and Group 2 received 2 daily doses of 1 mg/kg enoxaparin sodium.
Results: A total of 191 patients were included in the study. 45% of the patients were female (n: 86), 55% were male. The mean age was found to be 67.6 ± 13.8. Patient numbers; group 0: 12, group 1: 90, group 2: 89. 7-day mortality was 50% in group 0, 22.2% in group 2, and 23.5% in group 3 (p value <0.05).
Conclusion: In a recent lung dissection report in critically ill patient with COVID-19; occlusion of pulmonary small vessels and formation of microthrombosis have been demonstrated. Prophylactic doses of LMWH are used more frequently. Some studies have suggested that septic patients may benefit from early diagnosis and specific treatment. As a result; in severe COVID-19 patients with limited mobilization, all doses of LMWH reduce morbidity and mortality.

Keywords: COVID-19, LMWH (Low molecular weight heparin), intensive care

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Þiddetli COVÝD-19 Hastalarýnda DMAH (Düþük Molekül Aðýrlýklý Heparin) Doz Farklýlýklarýnýn Etkileri

Mine Altýnkaya Çavuþ, Hafize Sav
Kayseri Þehir Hastanesi

Amaç: Þiddetli COVÝD-19 hastalarýnda göze çarpan en önemli klinik bulgu endotel hasarýdýr. Bu nedenle þiddetli COVÝD-19 hastalarýna antikoagülanlarýn (heparin gibi) aktif olarak uygulanmasý önerilmektedir. Bu çalýþmada amaç, tedavide kullanýlan DMAH doz farlýlýklarýnýn, þiddetli COVÝD-19 hastalarý üzerindeki etkilerini araþtýrmaktýr.
Yöntem: Çalýþma, 3. basamak yoðun bakým ünitesinde, retrospektif olarak yapýldý. PCR (Polimeraz zincir reaksiyonu) pozitif (+) hastalar çalýþmaya dâhil edildi. Hastalarýn demografik verileri, hastanede ve yoðun bakýmda kalýþ süreleri, yoðun bakým yatýþlarýnýn son günündeki laboratuvar deðerleri (D-dimer, CRP, kreatinin), mortalite ile invaziv mekanik ventilatör gereksinimleri kaydedildi. Grup O: antikoagülan almayan, grup 1: günde 1 doz enoksaparin sodyum: 40 mg (4000 anti-Xa IU’ya eþdeðer), grup 2: günde 2 doz enoksaparin sodyum: 1 mg/kg alan hastalardan oluþuyordu.
Bulgular: Çalýþmaya toplam 191 hasta dâhil edildi. Hastalardan %45’i kadýn (n: 86), %55’i erkekti. Ortalama yaþ 67.6±13.8 olarak bulundu. Hasta sayýlarý; Grup 0: 12, Grup 1: 90, Grup 2: 89 idi. Grup 0’da 7 günlük mortalite %50, Grup 2’de %22,2, Grup 3’te %23,5 olarak saptandý (p deðeri <0,05).
Sonuç: COVÝD-19’lu kritik hastada yapýlan yakýn tarihli bir akciðer diseksiyonu raporunda; pulmoner küçük damarlarý týkanma ve mikrotromboz oluþumu gösterilmiþtir. DMAH’in profilaktik dozlarý daha sýk kullanýlmaktadýr. Bazý çalýþmalarda, septik hastalarýn erken teþhis ve spesifik tedaviden yarar saðlayabileceði öne sürülmüþtür. Sonuç olarak, mobilizasyonu sýnýrlý olan aðýr COVÝD-19 hastalarýnda DMAH’in tüm dozlarý morbidite ve mortaliteyi azaltýr.

Anahtar Kelimeler: COVÝD-19, DMAH (Düþük molekül aðýrlýklý heparin), yoðun bakým

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