{"title":"Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19","authors":"Pilar Marcos-Neira , Cristian Morales-Indiano , Mariana Fernández-Caballero , Teresa Tomasa-Irriguible , Luisa Bordejé-Laguna , Víctor Ruíz-Artola","doi":"10.1016/j.medine.2024.07.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.</div></div><div><h3>Design</h3><div>Single center prospective observational longitudinal cohort study (February–November 2021).</div></div><div><h3>Setting</h3><div>Patients admitted to the ICU of a University Hospital.</div></div><div><h3>Participants</h3><div>Patients with severe COVID-19 pneumoniae.</div></div><div><h3>Interventions</h3><div>Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.</div></div><div><h3>Main variables of interest</h3><div>Target: thomboembolic events.</div><div>Predictors: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results.</div><div>Logistic regression was used to identify independent risk factors for thomboembolic events.</div></div><div><h3>Results</h3><div>Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.</div></div><div><h3>Conclusions</h3><div>Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 78-87"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicina intensiva","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2173572724001917","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.
Design
Single center prospective observational longitudinal cohort study (February–November 2021).
Setting
Patients admitted to the ICU of a University Hospital.
Participants
Patients with severe COVID-19 pneumoniae.
Interventions
Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.
Main variables of interest
Target: thomboembolic events.
Predictors: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results.
Logistic regression was used to identify independent risk factors for thomboembolic events.
Results
Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.
Conclusions
Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.