Bavinash Pillay, Sarah A van Blydenstein, Shahed Omar
{"title":"COVID-19患者的血栓弹性成像：南非背景下的一项观察性研究","authors":"Bavinash Pillay, Sarah A van Blydenstein, Shahed Omar","doi":"10.4102/ajlm.v14i1.2681","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) increases the risk of venous thromboembolism, requiring monitoring of low molecular weight heparin (LMWH) via a time-consuming, costly and often unavailable test - anti-factor Xa (anti-Xa). An affordable, rapid point-of-care alternative, the thromboelastogram, is available, but performance comparisons to anti-Xa are lacking.</p><p><strong>Objective: </strong>This study evaluated the relationship between anti-Xa and thromboelastogram in patients with COVID-19 receiving LMWH.</p><p><strong>Methods: </strong>This was a retrospective study of patients with COVID-19 receiving LMWH at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, between November 2020 and January 2021. Blood samples tested with thromboelastogram and anti-Xa were drawn at three timepoints (one prior to and two after administration of LMWH). Thromboelastogram parameters comprised reaction time (R-time; onset of testing to the start of clot formation), kinetics time (K-time; start of clot formation until the clot reached 20 mm), and thromboelastogram coagulation index (overall coagulation status of whole blood).</p><p><strong>Results: </strong>Forty-two patients with COVID-19 (15 male and 27 female) met the study criteria. There was a statistically significant, low to moderate correlation (Spearman's correlation coefficient [<i>r</i> <sub>s</sub> 0.43, <i>p</i> = 0.014]) between anti-Xa and thromboelastogram coagulation index. A statistically significant moderate correlation (<i>r</i> <sub>s</sub> 0.52, <i>p</i> = 0.002) between anti-Xa and R-time, and a statistically significant low correlation (<i>r</i> <sub>s</sub> 0.35, <i>p</i> = 0.049) between anti-Xa and K-time, were found. All correlations were 48 h post admission.</p><p><strong>Conclusion: </strong>Thromboelastogram coagulation index, R-times and K-times had a statistically significant association with anti-Xa levels in patients with COVID-19. Further research is required regarding their clinical utility.</p><p><strong>What this study adds: </strong>Thromboelastograms may represent a more cost-effective and accessible option to the conventional anti-Xa test in patients receiving LMWH. 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An affordable, rapid point-of-care alternative, the thromboelastogram, is available, but performance comparisons to anti-Xa are lacking.</p><p><strong>Objective: </strong>This study evaluated the relationship between anti-Xa and thromboelastogram in patients with COVID-19 receiving LMWH.</p><p><strong>Methods: </strong>This was a retrospective study of patients with COVID-19 receiving LMWH at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, between November 2020 and January 2021. Blood samples tested with thromboelastogram and anti-Xa were drawn at three timepoints (one prior to and two after administration of LMWH). 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引用次数: 0
摘要
背景：2019冠状病毒病（COVID-19）增加了静脉血栓栓塞的风险，需要通过一种耗时、昂贵且往往无法获得的检测方法——抗Xa因子（anti-Xa）来监测低分子肝素（LMWH）。血栓弹性图是一种可负担得起的、快速的即时治疗替代方案，但缺乏与抗xa的性能比较。目的：探讨低分子肝素治疗的COVID-19患者抗xa与血栓弹性图的关系。方法：回顾性研究了2020年11月至2021年1月在南非约翰内斯堡Chris Hani Baragwanath学术医院接受低分子肝素治疗的COVID-19患者。在三个时间点（给药前和给药后）抽取血液样本进行血栓弹性图和抗xa检测。血栓弹性图参数包括反应时间(R-time；检测开始至凝块形成开始)，动力学时间(K-time；血栓形成开始至血栓达到20mm)，血栓弹性图凝血指数（全血总体凝血状态）。结果：42例COVID-19患者（男15例，女27例）符合研究标准。抗xa与血栓弹性图凝血指数之间存在低至中度相关性（Spearman相关系数[r = 0.43, p = 0.014]），具有统计学意义。抗xa与r -time之间存在统计学上显著的中度相关性（r s 0.52, p = 0.002），抗xa与K-time之间存在统计学上显著的低相关性（r s 0.35, p = 0.049）。所有相关性均发生在入院后48小时。结论：新冠肺炎患者血栓弹性图凝血指数、r次、k次与抗xa水平有统计学意义。其临床应用还需进一步研究。本研究补充：在接受低分子肝素治疗的患者中，血栓弹性图可能是一种比传统的抗xa检测更具成本效益和可及性的选择。然而，未来的研究需要更大的样本量、不同的疾病概况和疾病的严重程度。
Thromboelastography in COVID-19 patients: An observational study in the South African context.
Background: Coronavirus disease 2019 (COVID-19) increases the risk of venous thromboembolism, requiring monitoring of low molecular weight heparin (LMWH) via a time-consuming, costly and often unavailable test - anti-factor Xa (anti-Xa). An affordable, rapid point-of-care alternative, the thromboelastogram, is available, but performance comparisons to anti-Xa are lacking.
Objective: This study evaluated the relationship between anti-Xa and thromboelastogram in patients with COVID-19 receiving LMWH.
Methods: This was a retrospective study of patients with COVID-19 receiving LMWH at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, between November 2020 and January 2021. Blood samples tested with thromboelastogram and anti-Xa were drawn at three timepoints (one prior to and two after administration of LMWH). Thromboelastogram parameters comprised reaction time (R-time; onset of testing to the start of clot formation), kinetics time (K-time; start of clot formation until the clot reached 20 mm), and thromboelastogram coagulation index (overall coagulation status of whole blood).
Results: Forty-two patients with COVID-19 (15 male and 27 female) met the study criteria. There was a statistically significant, low to moderate correlation (Spearman's correlation coefficient [rs 0.43, p = 0.014]) between anti-Xa and thromboelastogram coagulation index. A statistically significant moderate correlation (rs 0.52, p = 0.002) between anti-Xa and R-time, and a statistically significant low correlation (rs 0.35, p = 0.049) between anti-Xa and K-time, were found. All correlations were 48 h post admission.
Conclusion: Thromboelastogram coagulation index, R-times and K-times had a statistically significant association with anti-Xa levels in patients with COVID-19. Further research is required regarding their clinical utility.
What this study adds: Thromboelastograms may represent a more cost-effective and accessible option to the conventional anti-Xa test in patients receiving LMWH. However, future research with larger sample sizes, varying disease profiles, and severity of illness is required.
期刊介绍：
The African Journal of Laboratory Medicine, the official journal of ASLM, focuses on the role of the laboratory and its professionals in the clinical and public healthcare sectors,and is specifically based on an African frame of reference. Emphasis is on all aspects that promote and contribute to the laboratory medicine practices of Africa. This includes, amongst others: laboratories, biomedical scientists and clinicians, medical community, public health officials and policy makers, laboratory systems and policies (translation of laboratory knowledge, practices and technologies in clinical care), interfaces of laboratory with medical science, laboratory-based epidemiology, laboratory investigations, evidence-based effectiveness in real world (actual) settings.
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