A novel description of AT deficiency in hospitalized COVID-19 patients.

IF 3.3 4区医学 Q1 Medicine

European review for medical and pharmacological sciences Pub Date : 2025-01-01 DOI:10.26355/eurrev_202501_37057

B M Parker, K G Proctor, R Guerra, R J Manning, V Aguilar, J P Meizoso, A Pastewski, W Sneij, A C Marttos, C F O'Neil, W A Ramsey, N Namias, E Ginzburg

{"title":"A novel description of AT deficiency in hospitalized COVID-19 patients.","authors":"B M Parker, K G Proctor, R Guerra, R J Manning, V Aguilar, J P Meizoso, A Pastewski, W Sneij, A C Marttos, C F O'Neil, W A Ramsey, N Namias, E Ginzburg","doi":"10.26355/eurrev_202501_37057","DOIUrl":null,"url":null,"abstract":"Objective: Antithrombin (AT) has anti-inflammatory and anti-coagulant properties, but its role in COVID-19 and the rate of deficiency is unknown. We hypothesize that AT3 deficiency is common in COVID-19, and supplementing AT3 will impact COVID-19 coagulopathy.Patients and methods: This is a prospective randomized control trial. Patients with plasma AT3<100% were randomized to either standard of care (SOC) or SOC+AT3 q48hr weight-based for a goal of 120% for up to 5 doses. An additional reference group with AT3>100% received SOC.Results: 531 subjects were assessed for eligibility; 324 did not meet inclusion criteria, 151 did not consent, 6 withdrew consent, and 50 subjects completed the study. Enrollment AT3 (M±SD) was 91±13%. AT3 levels were <100% in 38 (76%) and <80% in 11 (22%) patients. SOC+AT3, SOC only, and AT3>100% had a disseminated intravascular coagulation (DIC) score change (M±SD) of 0.4±1.5, -0.13±1.85 and 0±1.54, respectively, (p=0.63). Hospital length of stay was 11.7 [6-14], 6 [4.5-10], 8.5 [6-21] respectively, (p=0.176). Mortality occurred in 2 (11%), 3 (15%), and 3 (25%) patients, respectively (p=0.56). There was one bleeding event in a subject with AT3>100%, and no bleeding events were observed with exogenous AT3. There were no observed drug-related adverse events. Subjects received a median dose of 1,825.5 IU (IQR 794).Conclusions: COVID-19 is associated with relative AT3 deficiency (22% of this cohort). No bleeding complications or drug-related adverse events with exogenous AT3 were observed. There were no significant differences in length of stay or mortality. Further studies should evaluate higher doses of exogenous AT3 and focus on higher-risk groups.Clinicaltrials: gov: NCT04899232.","PeriodicalId":12152,"journal":{"name":"European review for medical and pharmacological sciences","volume":"29 1","pages":"30-38"},"PeriodicalIF":3.3000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European review for medical and pharmacological sciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.26355/eurrev_202501_37057","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: Antithrombin (AT) has anti-inflammatory and anti-coagulant properties, but its role in COVID-19 and the rate of deficiency is unknown. We hypothesize that AT3 deficiency is common in COVID-19, and supplementing AT3 will impact COVID-19 coagulopathy.

Patients and methods: This is a prospective randomized control trial. Patients with plasma AT3<100% were randomized to either standard of care (SOC) or SOC+AT3 q48hr weight-based for a goal of 120% for up to 5 doses. An additional reference group with AT3>100% received SOC.

Results: 531 subjects were assessed for eligibility; 324 did not meet inclusion criteria, 151 did not consent, 6 withdrew consent, and 50 subjects completed the study. Enrollment AT3 (M±SD) was 91±13%. AT3 levels were <100% in 38 (76%) and <80% in 11 (22%) patients. SOC+AT3, SOC only, and AT3>100% had a disseminated intravascular coagulation (DIC) score change (M±SD) of 0.4±1.5, -0.13±1.85 and 0±1.54, respectively, (p=0.63). Hospital length of stay was 11.7 [6-14], 6 [4.5-10], 8.5 [6-21] respectively, (p=0.176). Mortality occurred in 2 (11%), 3 (15%), and 3 (25%) patients, respectively (p=0.56). There was one bleeding event in a subject with AT3>100%, and no bleeding events were observed with exogenous AT3. There were no observed drug-related adverse events. Subjects received a median dose of 1,825.5 IU (IQR 794).

Conclusions: COVID-19 is associated with relative AT3 deficiency (22% of this cohort). No bleeding complications or drug-related adverse events with exogenous AT3 were observed. There were no significant differences in length of stay or mortality. Further studies should evaluate higher doses of exogenous AT3 and focus on higher-risk groups.

Clinicaltrials: gov: NCT04899232.

查看原文本刊更多论文

住院COVID-19患者AT缺乏的新描述

目的：抗凝血酶（AT）具有抗炎和抗凝血的特性，但其在COVID-19中的作用和缺乏率尚不清楚。我们假设AT3缺乏症在COVID-19中很常见，补充AT3会影响COVID-19凝血功能。患者和方法：这是一项前瞻性随机对照试验。血浆AT3100%的患者接受SOC治疗。结果：531名受试者被评估为合格；324例不符合纳入标准，151例不同意，6例撤回同意，50例受试者完成了研究。入组AT3 （M±SD）为91±13%。AT3水平为100%时弥散性血管内凝血（DIC）评分变化（M±SD）分别为0.4±1.5,-0.13±1.85和0±1.54,（p=0.63）。住院时间分别为11.7[6-14]、6[4.5-10]、8.5[6-21]，差异有统计学意义（p=0.176）。分别有2例（11%）、3例（15%）和3例（25%）患者死亡（p=0.56）。在AT3浓度为100%的受试者中有1例出血事件，外源性AT3未观察到出血事件。没有观察到药物相关的不良事件。受试者接受的中位剂量为1825.5 IU （IQR 794）。结论：COVID-19与AT3相对缺乏相关（占该队列的22%）。未观察到外源性AT3的出血并发症或药物相关不良事件。在住院时间和死亡率方面没有显著差异。进一步的研究应评估更高剂量的外源性AT3，并关注高风险人群。Clinicaltrials: gov: NCT04899232。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European review for medical and pharmacological sciences 医学-药学

CiteScore

5.30

自引率

6.10%

发文量

906

审稿时长

2-4 weeks

期刊介绍： European Review for Medical and Pharmacological Sciences, a fortnightly journal, acts as an information exchange tool on several aspects of medical and pharmacological sciences. It publishes reviews, original articles, and results from original research. The purposes of the Journal are to encourage interdisciplinary discussions and to contribute to the advancement of medicine. European Review for Medical and Pharmacological Sciences includes: -Editorials- Reviews- Original articles- Trials- Brief communications- Case reports (only if of particular interest and accompanied by a short review)