Heparin resistance in COVID-19 patients in the intensive care unit
Top Cited Papers
Open Access
- 22 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Thrombosis and Thrombolysis
- Vol. 50 (2), 287-291
- https://doi.org/10.1007/s11239-020-02145-0
Abstract
Patients with COVID-19 have a coagulopathy and high thrombotic risk. In a cohort of 69 intensive care unit (ICU) patients we investigated for evidence of heparin resistance in those that have received therapeutic anticoagulation. 15 of the patients have received therapeutic anticoagulation with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH), of which full information was available on 14 patients. Heparin resistance to UFH was documented in 8/10 (80%) patients and sub-optimal peak anti-Xa following therapeutic LMWH in 5/5 (100%) patients where this was measured (some patients received both anticoagulants sequentially). Spiking plasma from 12 COVID-19 ICU patient samples demonstrated decreased in-vitro recovery of anti-Xa compared to normal pooled plasma. In conclusion, we have found evidence of heparin resistance in critically unwell COVID-19 patients. Further studies investigating this are required to determine the optimal thromboprophylaxis in COVID-19 and management of thrombotic episodes.Keywords
This publication has 20 references indexed in Scilit:
- The importance of commutability in material used for quality control purposesInternational Journal of Laboratory Hematology, 2018
- Predictors of Heparin Resistance Before Cardiovascular Operations in AdultsThe Annals of Thoracic Surgery, 2018
- Should we abandon the APTT for monitoring unfractionated heparin?Thrombosis Research, 2017
- Heparin Sensitivity and ResistanceAnesthesia & Analgesia, 2013
- Parenteral Anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice GuidelinesSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- Monitoring heparin anticoagulation in the acute phase responseBritish Journal of Haematology, 2010
- Anti-Xa activity after subcutaneous administration of dalteparin in ICU patients with and without subcutaneous oedema: a pilot studyCritical Care, 2006
- Heparin clearance during continuous veno-venous haemofiltrationIntensive Care Medicine, 1994
- A Randomized Trial Comparing Activated Thromboplastin Time With Heparin Assay in Patients With Acute Venous Thromboembolism Requiring Large Daily Doses of HeparinArchives of Internal Medicine, 1994