A retrospective multicenter cohort study of the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19
(2023) In Thrombosis Journal 21. p.1-11- Abstract
BACKGROUND: Patients with critical COVID-19 have a high risk of thromboembolism, but intensified thromboprophylaxis has not been proven beneficial. The activity of low-molecular-weight heparins can be monitored by measuring anti-Factor Xa. We aimed to study the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19.
METHOD: This retrospective cohort study included adult patients with critical COVID-19 admitted to an intensive care unit at three Swedish hospitals between March 2020 and May 2021 with at least one valid peak and/or trough anti-Factor Xa value. Within the peak and trough categories, patients' minimum, median, and maximum values were determined. Logistic... (More)
BACKGROUND: Patients with critical COVID-19 have a high risk of thromboembolism, but intensified thromboprophylaxis has not been proven beneficial. The activity of low-molecular-weight heparins can be monitored by measuring anti-Factor Xa. We aimed to study the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19.
METHOD: This retrospective cohort study included adult patients with critical COVID-19 admitted to an intensive care unit at three Swedish hospitals between March 2020 and May 2021 with at least one valid peak and/or trough anti-Factor Xa value. Within the peak and trough categories, patients' minimum, median, and maximum values were determined. Logistic regressions with splines were used to assess associations.
RESULTS: In total, 408 patients had at least one valid peak and/or trough anti-Factor Xa measurement, resulting in 153 patients with peak values and 300 patients with trough values. Lower peak values were associated with thromboembolism for patients' minimum (p = 0.01), median (p = 0.005) and maximum (p = 0.001) values. No association was seen between peak values and death or bleeding. Higher trough values were associated with death for median (p = 0.03) and maximum (p = 0.002) values and with both bleeding (p = 0.01) and major bleeding (p = 0.02) for maximum values, but there were no associations with thromboembolism.
CONCLUSIONS: Measuring anti-Factor Xa activity may be relevant for administrating low-molecular-weight heparin to patients with critical COVID-19. Lower peak values were associated with an increased risk of thromboembolism, and higher trough values were associated with an increased risk of death and bleeding. Prospective studies are needed to confirm the results.
TRIAL REGISTRATION: The study was retrospectively registered at Clinicaltrials.gov, NCT05256524, February 24, 2022.
(Less)
- author
- Jonmarker, Sandra
; Litorell, Jacob
; Alarcon, Felix
; Al-Abani, Kais
; Björkman, Sofia
; Farm, Maria
; Grip, Jonathan
; Söderberg, Mårten
; Hollenberg, Jacob
; Wahlin, Rebecka Rubenson
; Kander, Thomas
LU
; Rimling, Liivi
; Mårtensson, Johan
; Joelsson-Alm, Eva
; Dahlberg, Martin
and Cronhjort, Maria
(Less) - organization
- publishing date
- 2023-10-02
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Thrombosis Journal
- volume
- 21
- article number
- 101
- pages
- 1 - 11
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85173728517
- pmid:37784131
- ISSN
- 1477-9560
- DOI
- 10.1186/s12959-023-00541-z
- language
- English
- LU publication?
- yes
- additional info
- © 2023. BioMed Central Ltd., part of Springer Nature.
- id
- 7784c8da-d9fa-430b-bf6a-691ccc5bcb09
- date added to LUP
- 2023-10-08 14:24:20
- date last changed
- 2024-04-24 06:39:17
@article{7784c8da-d9fa-430b-bf6a-691ccc5bcb09,
abstract = {{<p>BACKGROUND: Patients with critical COVID-19 have a high risk of thromboembolism, but intensified thromboprophylaxis has not been proven beneficial. The activity of low-molecular-weight heparins can be monitored by measuring anti-Factor Xa. We aimed to study the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19.</p><p>METHOD: This retrospective cohort study included adult patients with critical COVID-19 admitted to an intensive care unit at three Swedish hospitals between March 2020 and May 2021 with at least one valid peak and/or trough anti-Factor Xa value. Within the peak and trough categories, patients' minimum, median, and maximum values were determined. Logistic regressions with splines were used to assess associations.</p><p>RESULTS: In total, 408 patients had at least one valid peak and/or trough anti-Factor Xa measurement, resulting in 153 patients with peak values and 300 patients with trough values. Lower peak values were associated with thromboembolism for patients' minimum (p = 0.01), median (p = 0.005) and maximum (p = 0.001) values. No association was seen between peak values and death or bleeding. Higher trough values were associated with death for median (p = 0.03) and maximum (p = 0.002) values and with both bleeding (p = 0.01) and major bleeding (p = 0.02) for maximum values, but there were no associations with thromboembolism.</p><p>CONCLUSIONS: Measuring anti-Factor Xa activity may be relevant for administrating low-molecular-weight heparin to patients with critical COVID-19. Lower peak values were associated with an increased risk of thromboembolism, and higher trough values were associated with an increased risk of death and bleeding. Prospective studies are needed to confirm the results.</p><p>TRIAL REGISTRATION: The study was retrospectively registered at Clinicaltrials.gov, NCT05256524, February 24, 2022.</p>}},
author = {{Jonmarker, Sandra and Litorell, Jacob and Alarcon, Felix and Al-Abani, Kais and Björkman, Sofia and Farm, Maria and Grip, Jonathan and Söderberg, Mårten and Hollenberg, Jacob and Wahlin, Rebecka Rubenson and Kander, Thomas and Rimling, Liivi and Mårtensson, Johan and Joelsson-Alm, Eva and Dahlberg, Martin and Cronhjort, Maria}},
issn = {{1477-9560}},
language = {{eng}},
month = {{10}},
pages = {{1--11}},
publisher = {{BioMed Central (BMC)}},
series = {{Thrombosis Journal}},
title = {{A retrospective multicenter cohort study of the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19}},
url = {{http://dx.doi.org/10.1186/s12959-023-00541-z}},
doi = {{10.1186/s12959-023-00541-z}},
volume = {{21}},
year = {{2023}},
}