Platelet Count Rose While D-Dimer Levels Dropped as Deaths and Thrombosis Declined-An Observational Study on Anticoagulation Shift in COVID-19.
Administration, Oral
Aged
Anticoagulants
/ administration & dosage
Biomarkers
/ blood
Blood Platelets
/ drug effects
COVID-19
/ blood
Female
Fibrin Fibrinogen Degradation Products
/ metabolism
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Sweden
/ epidemiology
Thrombosis
/ blood
Time Factors
Treatment Outcome
COVID-19 Drug Treatment
Journal
Thrombosis and haemostasis
ISSN: 2567-689X
Titre abrégé: Thromb Haemost
Pays: Germany
ID NLM: 7608063
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
pubmed:
9
4
2021
medline:
15
12
2021
entrez:
8
4
2021
Statut:
ppublish
Résumé
High levels of D-dimer and low platelet counts are associated with poor outcome in coronavirus disease 2019 (COVID-19). As anticoagulation appeared to improve survival, hospital-wide recommendations regarding higher doses of anticoagulation were implemented on April 9, 2020. To investigate if trends in D-dimer levels and platelet counts were associated with death, thrombosis, and the shift in anticoagulation. Retrospective cohort study of 429 patients with COVID-19 at Karolinska University Hospital. Information on D-dimer levels and platelet counts was obtained from laboratory databases and clinical data from medical records. Thirty-day mortality and thrombosis rates were 19% and 18%, respectively. Pulmonary embolism was common, 65/83 (78%). Increased D-dimer levels in the first week in hospital were significantly associated with death and thrombosis (odds ratio [OR]: 6.06; 95% confidence interval [CL]: 2.10-17.5 and 3.11; 95% CI: 1.20-8.10, respectively). If platelet count increased more than 35 × 10 In contrast to D-dimer levels, increase of platelet count over the first week in hospital was associated with improved survival and reduced thrombotic risk. The daily mean levels of D-dimer dropped while the platelet counts rose, coinciding with increased anticoagulation and a decline in thrombotic burden and mortality.
Sections du résumé
BACKGROUND
BACKGROUND
High levels of D-dimer and low platelet counts are associated with poor outcome in coronavirus disease 2019 (COVID-19). As anticoagulation appeared to improve survival, hospital-wide recommendations regarding higher doses of anticoagulation were implemented on April 9, 2020.
OBJECTIVES
OBJECTIVE
To investigate if trends in D-dimer levels and platelet counts were associated with death, thrombosis, and the shift in anticoagulation.
METHODS
METHODS
Retrospective cohort study of 429 patients with COVID-19 at Karolinska University Hospital. Information on D-dimer levels and platelet counts was obtained from laboratory databases and clinical data from medical records.
RESULTS
RESULTS
Thirty-day mortality and thrombosis rates were 19% and 18%, respectively. Pulmonary embolism was common, 65/83 (78%). Increased D-dimer levels in the first week in hospital were significantly associated with death and thrombosis (odds ratio [OR]: 6.06; 95% confidence interval [CL]: 2.10-17.5 and 3.11; 95% CI: 1.20-8.10, respectively). If platelet count increased more than 35 × 10
CONCLUSION
CONCLUSIONS
In contrast to D-dimer levels, increase of platelet count over the first week in hospital was associated with improved survival and reduced thrombotic risk. The daily mean levels of D-dimer dropped while the platelet counts rose, coinciding with increased anticoagulation and a decline in thrombotic burden and mortality.
Substances chimiques
Anticoagulants
0
Biomarkers
0
Fibrin Fibrinogen Degradation Products
0
fibrin fragment D
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1610-1621Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
J.A. has received research grants from Shire, honoraria from Stago, Siemens, Sysmex, Roche, Baxter, and Sobi, and acts on advisory boards for Sobi and Novo Nordisk. M.B. acts on the advisory board for CSL Behringer and Sobi and has had consultant assignments for Novo Nordisk and received lecturer honoraria from Sobi.A.O. and M.B. were both supported by funds from Stockholm County Council. A.O. was supported by Swedish Carnegie Hero Funds. A.S., J.D.W., A.W., A.Å., and M.M. declare no competing financial interests.