Clinical evolution of patients with COVID-19: anticoagulation impact

Authors

DOI:

https://doi.org/10.33448/rsd-v11i9.31423

Keywords:

COVID-19; Evolution; Anticoagulation; Intensive Care Unit.

Abstract

A doença do coronavírus 19 (COVID-19) tem como alvo principal o sistema respiratório e evolui para forma grave em até 16% dos casos hospitalizados, com a instalação de transtornos tromboembólicos, sepse e morte. O objetivo deste estudo foi avaliar a evolução de pacientes com COVID-19, internados em unidade de terapia intensiva (UTI), observando os impactos da anticoagulação naqueles com parâmetros críticos. O objetivo deste estudo foi avaliar a evolução de pacientes com COVID-19, internados em unidade de terapia intensiva (UTI), observando os impactos da anticoagulação naqueles com parâmetros críticos. Estudo transversal, realizado com a revisão de prontuários de pacientes internados em UTI, com diagnóstico confirmado de COVID-19, no período compreendido entre março e dezembro de 2020, em um hospital geral no sul do Brasil. Dentre os 231 pacientes analisados, observou-se letalidade de 66,2%. Dentre os achados mais relevantes associados à óbito estão a presença de cardiopatia e hipertensão arterial sistêmica (HAS) prévia, evolução clínica com insuficiência renal e clearance <30 e hiperbilirrubinemia. Dos 103 pacientes internados que estavam com anticoagulação sob parâmetros críticos, 88 evoluíram com óbito. Foram associados à mortalidade a idade avançada (≥ 60 anos), presença de comorbidades, complicações durante a internação, alterações laboratoriais e evolução com hepatite transinfecciosa. Anticoagulação sob parâmetros críticos foi associada à maior taxa de óbito, com evolução clínica entre admissão em UTI e desfecho fatal após duas semanas de infecção.

References

Asakura, H., Takahashi, H., Uchiyama, T., Eguchi, Y., Okamoto, K., Kawasugi, K., Madoiwa, S., Wada, H., & DIC subcommittee of the Japanese Society on Thrombosis and Hemostasis (2016). Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thrombosis journal, 14, 42.

Chai, X., Hu, L., Zhang, Y., Han, W., Lu, Z., Ke, A., ... & Lan, F. (2020). Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. biorxiv.

Chan, L., Chaudhary, K., Saha, A., Chauhan, K., Vaid, A., Zhao, S., Paranjpe, I., Somani, S., Richter, F., Miotto, R., Lala, A., Kia, A., Timsina, P., Li, L., Freeman, R., Chen, R., Narula, J., Just, A. C., Horowitz, C., Fayad, Z., … Mount Sinai COVID Informatics Center (MSCIC) (2021). AKI in Hospitalized Patients with COVID-19. Journal of the American Society of Nephrology : JASN, 32(1), 151–160.

Cheng, Y., Luo, R., Wang, K., Zhang, M., Wang, Z., Dong, L., Li, J., Yao, Y., Ge, S., & Xu, G. (2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney international, 97(5), 829–838.

Cronin, M., Dengler, N., Krauss, E. S., Segal, A., Wei, N., Daly, M., ... & Caprini, J. A. (2019). Completion of the updated Caprini risk assessment model (2013 version). Clinical and Applied Thrombosis/Hemostasis, 25, 1076029619838052.

Darzi, A. J., Repp, A. B., Spencer, F. A., Morsi, R. Z., Charide, R., Etxeandia-Ikobaltzeta, I., Bauer, K. A., Burnett, A. E., Cushman, M., Dentali, F., Kahn, S. R., Rezende, S. M., Zakai, N. A., Agarwal, A., Karam, S. G., Lotfi, T., Wiercioch, W., Waziry, R., Iorio, A., Akl, E. A., … Schünemann, H. J. (2020). Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews. Blood advances, 4(19), 4929–4944.

Ertuğlu, L. A., Kanbay, A., Afşar, B., Elsürer Afşar, R., & Kanbay, M. (2020). COVID-19 and acute kidney injury. COVID-19 ve akut böbrek hasarı. Tuberkuloz ve toraks, 68(4), 407–418.

Espinosa, O. A., Zanetti, A., Antunes, E. F., Longhi, F. G., Matos, T. A., & Battaglini, P. F. (2020). Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis. Revista do Instituto de Medicina Tropical de Sao Paulo, 62, e43.

Goha, A., Mezue, K., Edwards, P., Nunura, F., Baugh, D., & Madu, E. (2020). COVID-19 and the heart: An update for clinicians. Clinical cardiology, 43(11), 1216–1222.

Guan, W. J., Liang, W. H., Zhao, Y., Liang, H. R., Chen, Z. S., Li, Y. M., Liu, X. Q., Chen, R. C., Tang, C. L., Wang, T., Ou, C. Q., Li, L., Chen, P. Y., Sang, L., Wang, W., Li, J. F., Li, C. C., Ou, L. M., Cheng, B., Xiong, S., … China Medical Treatment Expert Group for COVID-19 (2020). Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. The European respiratory journal, 55(5), 2000547.

Hadid, T., Kafri, Z., & Al-Katib, A. (2021). Coagulation and anticoagulation in COVID-19. Blood reviews, 47, 100761.

Hippensteel, J. A., LaRiviere, W. B., Colbert, J. F., Langouët-Astrié, C. J., & Schmidt, E. P. (2020). Heparin as a therapy for COVID-19: current evidence and future possibilities. American journal of physiology. Lung cellular and molecular physiology, 319(2), L211–L217.

Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., Xiao, Y., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England), 395(10223), 497–506.

Iba, T., Nisio, M. D., Levy, J. H., Kitamura, N., & Thachil, J. (2017). New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey. BMJ open, 7(9), e017046.

Klok, F. A., Kruip, M., van der Meer, N., Arbous, M. S., Gommers, D., Kant, K. M., Kaptein, F., van Paassen, J., Stals, M., Huisman, M. V., & Endeman, H. (2020). Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis research, 191, 145–147.

Kudose, S., Batal, I., Santoriello, D., Xu, K., Barasch, J., Peleg, Y., Canetta, P., Ratner, L. E., Marasa, M., Gharavi, A. G., Stokes, M. B., Markowitz, G. S., & D'Agati, V. D. (2020). Kidney Biopsy Findings in Patients with COVID-19. Journal of the American Society of Nephrology : JASN, 31(9), 1959–1968.

Levey, A. S., Becker, C., & Inker, L. A. (2015). Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. JAMA, 313(8), 837–846.

Li, J., Huang, D. Q., Zou, B., Yang, H., Hui, W. Z., Rui, F., Yee, N., Liu, C., Nerurkar, S. N., Kai, J., Teng, M., Li, X., Zeng, H., Borghi, J. A., Henry, L., Cheung, R., & Nguyen, M. H. (2021). Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. Journal of medical virology, 93(3), 1449–1458.

Li, X., Xu, S., Yu, M., Wang, K., Tao, Y., Zhou, Y., Shi, J., Zhou, M., Wu, B., Yang, Z., Zhang, C., Yue, J., Zhang, Z., Renz, H., Liu, X., Xie, J., Xie, M., & Zhao, J. (2020). Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. The Journal of allergy and clinical immunology, 146(1), 110–118.

McBane, R. D., 2nd, Torres Roldan, V. D., Niven, A. S., Pruthi, R. K., Franco, P. M., Linderbaum, J. A., Casanegra, A. I., Oyen, L. J., Houghton, D. E., Marshall, A. L., Ou, N. N., Siegel, J. L., Wysokinski, W. E., Padrnos, L. J., Rivera, C. E., Flo, G. L., Shamoun, F. E., Silvers, S. M., Nayfeh, T., Urtecho, M., … Murad, M. H. (2020). Anticoagulation in COVID-19: A Systematic Review, Meta-analysis, and Rapid Guidance From Mayo Clinic. Mayo Clinic proceedings, 95(11), 2467–2486.

Miesbach, W., & Makris, M. (2020). COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 26, 1076029620938149.

Minet, C., Potton, L., Bonadona, A., Hamidfar-Roy, R., Somohano, C. A., Lugosi, M., Cartier, J. C., Ferretti, G., Schwebel, C., & Timsit, J. F. (2015). Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis. Critical care (London, England), 19(1), 287.

Moores, L. K., Tritschler, T., Brosnahan, S., Carrier, M., Collen, J. F., Doerschug, K., ... & Wells, P. (2020). Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019: CHEST guideline and expert panel report. Chest, 158(3), 1143-1163.

Petrilli, C. M., Jones, S. A., Yang, J., Rajagopalan, H., O'Donnell, L., Chernyak, Y., Tobin, K. A., Cerfolio, R. J., Francois, F., & Horwitz, L. I. (2020). Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ (Clinical research ed.), 369, m1966.

Puelles, V. G., Lütgehetmann, M., Lindenmeyer, M. T., Sperhake, J. P., Wong, M. N., Allweiss, L., Chilla, S., Heinemann, A., Wanner, N., Liu, S., Braun, F., Lu, S., Pfefferle, S., Schröder, A. S., Edler, C., Gross, O., Glatzel, M., Wichmann, D., Wiech, T., Kluge, S., … Huber, T. B. (2020). Multiorgan and Renal Tropism of SARS-CoV-2. The New England journal of medicine, 383(6), 590–592.

Rico-Mesa, J. S., Rosas, D., Ahmadian-Tehrani, A., White, A., Anderson, A. S., & Chilton, R. (2020). The Role of Anticoagulation in COVID-19-Induced Hypercoagulability. Current cardiology reports, 22(7), 53.

Ruan, Q., Yang, K., Wang, W., Jiang, L., & Song, J. (2020). Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive care medicine, 46(5), 846–848.

Salazar, M., Barochiner, J., Espeche, W., & Ennis, I. (2020). COVID-19, hipertensión y enfermedad cardiovascular [COVID-19 and its relationship with hypertension and cardiovascular disease]. Hipertension y riesgo vascular, 37(4), 176–180.

Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q., Huang, H., Yang, B., & Huang, C. (2020). Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA cardiology, 5(7), 802–810.

Spyropoulos, A. C., Levy, J. H., Ageno, W., Connors, J. M., Hunt, B. J., Iba, T., Levi, M., Samama, C. M., Thachil, J., Giannis, D., Douketis, J. D., & Subcommittee on Perioperative, Critical Care Thrombosis, Haemostasis of the Scientific, Standardization Committee of the International Society on Thrombosis and Haemostasis (2020). Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. Journal of thrombosis and haemostasis: JTH, 18(8), 1859–1865.

Tang, N., Bai, H., Chen, X., Gong, J., Li, D., & Sun, Z. (2020). Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of thrombosis and haemostasis : JTH, 18(5), 1094–1099.

Thachil, J., Tang, N., Gando, S., Falanga, A., Cattaneo, M., Levi, M., Clark, C., & Iba, T. (2020). ISTH interim guidance on recognition and management of coagulopathy in COVID-19. Journal of thrombosis and haemostasis : JTH, 18(5), 1023–1026.

Touzé, E., Varenne, O., Chatellier, G., Peyrard, S., Rothwell, P. M., & Mas, J. L. (2005). Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke, 36(12), 2748–2755.

Weston, S., & Frieman, M. B. (2020). COVID-19: Knowns, Unknowns, and Questions. mSphere, 5(2), e00203-20.

Williamson, D. R., Albert, M., Heels-Ansdell, D., Arnold, D. M., Lauzier, F., Zarychanski, R., Crowther, M., Warkentin, T. E., Dodek, P., Cade, J., Lesur, O., Lim, W., Fowler, R., Lamontagne, F., Langevin, S., Freitag, A., Muscedere, J., Friedrich, J. O., Geerts, W., Burry, L., … PROTECT collaborators, the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Group (2013). Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest, 144(4), 1207–1215.

Wong, Y. J., Tan, M., Zheng, Q., Li, J. W., Kumar, R., Fock, K. M., Teo, E. K., & Ang, T. L. (2020). A systematic review and meta-analysis of the COVID-19 associated liver injury. Annals of hepatology, 19(6), 627–634.

Zhai, Z., Li, C., Chen, Y., Gerotziafas, G., Zhang, Z., Wan, J., Liu, P., Elalamy, I., Wang, C., & Prevention Treatment of VTE Associated with COVID-19 Infection Consensus Statement Group (2020). Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thrombosis and haemostasis, 120(6), 937–948.

Zhang, J. J., Cao, Y. Y., Tan, G., Dong, X., Wang, B. C., Lin, J., Yan, Y. Q., Liu, G. H., Akdis, M., Akdis, C. A., & Gao, Y. D. (2021). Clinical, radiological, and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients. Allergy, 76(2), 533–550.

Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England), 395(10229), 1054–1062.

Downloads

Published

15/07/2022

How to Cite

OLIVEIRA, L. H. R. T. de .; REIS JUNIOR, N. A. dos .; GOMES, J. S.; SPÁRTALIS JUNIOR, P. B. .; MELLO, R. S. de .; SCHUELTER TREVISOL, F. Clinical evolution of patients with COVID-19: anticoagulation impact. Research, Society and Development, [S. l.], v. 11, n. 9, p. e46611931423, 2022. DOI: 10.33448/rsd-v11i9.31423. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/31423. Acesso em: 22 nov. 2024.

Issue

Section

Health Sciences