Anticoagulant Therapy in Moderate to Severe COVID-19 Patients

Agus Fitriyanto Achmad, Yuni Iswati Raharjani, Zidni Setyaningrum, Bagus Andi Pramono, Dita Ria Selvyana, Sri Pramesthi Wisnu Bowo Negoro

Abstract


Coronavirus disease-19 (COVID-19) has a spectrum of severity from no symptoms to serious complications. Coagulopathy is a serious complication of COVID-19, and that condition is a marker of poor prognosis. Anticoagulant drugs are often used as prophylaxis and thrombosis therapy to treat COVID-19 patients. Anticoagulant therapy is indicated for moderate-severe COVID-19 patients. Low molecular weight heparin (LMWH) and Unfractionated Heparin (UFH) are anticoagulant drugs of choice for prophylaxis and thrombosis therapy in COVID-19 patients. When administering anticoagulant drugs, monitoring bleeding, renal function, and platelet count needs to be done, even if only as thromboprophylaxis. LMWH and UFH have good clinical efficacy with minimal side effects in managing COVID-19 patients.


Keywords


Anticoagulant; Coagulopathy; COVID-19; Low-Molecular-Weight Heparin; Unfractionated Heparin

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References


Zhu H, Wei L, and Niu P. The novel coronavirus outbreak in Wuhan, China. Glob Health Res Policy. 2020 Dec;5(1):6. doi.org/10.1186/s41256-020-00135-6

Emami A, Javanmardi F, Pirbonyeh N, and Akbari A. Prevalence of Underlying Diseases in Hospitalized Pa- tients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2020; 8(1): e35: 1-14

Yi Y, Lagniton PNP, Ye S, and Li E, Xu R-H. COVID-19: what has been learned and to be learned about the novel coronavirus disease. Int J Biol Sci. 2020;16(10):1753–66.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–62.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020;382(18):1708–20.

Klok FA, Kruip MJHA, Van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020;191:145–7.

Llitjos JF, Leclerc M, Chochois C, Monsallier JM, Ramakers M, Auvray M, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. Journal of Thrombosis and Haemostasis. 2020;18(7):1743–6.

Vanderwerf JD, and Kumar MA. Management of neurologic complications of coagulopathies. 1st ed. Vol. 141, Handbook of Clinical Neurology. Elsevier B.V.; 2017. 743–764 p.

Suzuki K, Wada H, Imai H, Iba T, Thachil J, and Toh CH. A re-evaluation of the D-dimer cut-off value for making a diagnosis according to the ISTH overt-DIC diagnostic criteria: communication from the SSC of the ISTH. Journal of Thrombosis and Haemostasis. 2018;16(7):1442–4.

Iba T, Levy JH, Warkentin TE, Thachil J, van der Poll T, and Levi M. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. Journal of Thrombosis and Haemostasis. 2019;17(11):1989–94.

Toh CH, and Hoots WK. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: A 5-year overview. Journal of Thrombosis and Haemostasis. 2007;5(3):604–6.

Tang N, Li D, Wang X, and Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis. 2020;18(4):844–7.

Tang N, Bai H, Chen X, Gong J, Li D, and Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of Thrombosis and Haemostasis. 2020;18(5):1094–9.

Iba T, Levy JH, Levi M, Connors JM, and Thachil J. Coagulopathy of Coronavirus Disease 2019. Critical Care Medicine. 2020;48(9):1358–64.

Iba T, Levy JH, Wada H, Thachil J, Warkentin TE, and Levi M. Differential diagnoses for sepsis‐induced disseminated intravascular coagulation: communication from the SSC of the ISTH. Journal of Thrombosis and Haemostasis. 2019 Feb 7;17(2):415–9.

Levi M, and Scully M. How I treat disseminated intravascular coagulation. Blood. 2018;131(8):845–54.

Lippi G, Bonfanti L, Saccenti C, and Cervellin G. Causes of elevated D-dimer in patients admitted to a large urban emergency department. European Journal of Internal Medicine. 2014;25(1):45–8.

Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. Journal of Thrombosis and Haemostasis. 2020;18(6):1324–9.

Iba T, Levy JH, Thachil J, Wada H, and Levi M. The progression from coagulopathy to disseminated intravascular coagulation in representative underlying diseases. Thrombosis Research. 2019;179(January):11–4.

Delabranche X, Helms J, and Meziani F. Immunohaemostasis: a new view on haemostasis during sepsis. Annals of Intensive Care. 2017;7(1):1–14.

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. Journal of Thrombosis and Haemostasis. 2020;18(5):1023–6.

Godino C, Scotti A, Maugeri N, Mancini N, Fominskiy E, Margonato A, et al. Antithrombotic therapy in patients with COVID-19? -Rationale and Evidence-. International Journal of Cardiology. 2020;

Hirsh J. Low-Molecular-Weight Heparin: A Review of the Results of Recent Studies of the Treatment of Venous Thromboembolism and Unstable Angina. Circulation. 1998 Oct 13;98(15):1575–82.

Weitz J. Low-Molecular-Weight Heparin. The New England Journal of Medicine. 1997;688–98.

Dong K, Song Y, Li X, Ding J, Gao Z, Lu D, et al. Pentasaccharides for the prevention of venous thromboembolism. Cochrane Database of Systematic Reviews. 2016;2016(10).

Lazrak HH, René É, Elftouh N, Leblanc M, and Lafrance JP. Safety of low-molecular-weight heparin compared to unfractionated heparin in hemodialysis: a systematic review and meta-analysis. BMC Nephrology. 2017;18(1):1–12.

Stein PD, Kayali F, Olson RE, and Milford CE. Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: Analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census. American Journal of Medicine. 2004;116(7):435–42.

Zakai NA, and Mcclure LA. Racial differences in venous thromboembolism. Journal of Thrombosis and Haemostasis. 2011;9(10):1877–82.

Aikawa N, Shimazaki S, Yamamoto Y, Saito H, Maruyama I, Ohno R, et al. Thrombomodulin alfa in the treatment of infectious patients complicated by disseminated intravascular coagulation: Subanalysis from the phase 3 trial. Shock. 2011;35(4):349–54.

Liu XL, Wang XZ, Liu XX, Hao D, Jaladat Y, Lu F, et al. Low-dose heparin as treatment for early disseminated intravascular coagulation during sepsis: A prospective clinical study. Experimental and Therapeutic Medicine. 2014;7(3):604–8.

Iba T, Di Nisio M, Levy JH, Kitamura N, and Thachil J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: A retrospective analysis of a nationwide survey. BMJ Open. 2017;7(9):1–7.

Yu B, Li X, Chen J, Ouyang M, Zhang H, Zhao X, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis. 2020 Oct;50(3):548–57.

Krishnamurthy M, and Freedman ML. Complications of Anticoagulation with Heparin. Ethics Journal of the American Medical Association. April 2005:7(4). Available 1/7/2022 at https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-06/cprl1-0504.pdf

Warkentin TE, and Greinacher A. Heparin-induced thrombocytopenia: Recognition, treatment, and prevention - The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 SUPPL.):311S-337S.

Rice L. Heparin-induced thrombocytopenia: myths and misconceptions (that will cause trouble for you and your patient). Archives of internal medicine. 2004;164(18):1961–4.




DOI: https://doi.org/10.18196/mmjkk.v22i1.11634

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