基于肝素酶对比试验对COVID-19重型非ICU患者抗凝治疗出血风险的评估与分析OACSTPCD
Evaluation and analysis of bleeding risk of anticoagulation therapy in severe non-ICU patients with COVID-19 based on heparinase-modified TEG
目的 探讨肝素酶对比试验(heparinase-modified TEG,hmTEG)在评估COVID-19 重型非ICU患者凝血状态及抗凝治疗监测中的临床应用效果.方法 回顾性分析 2022 年12 月至2023 年5 月于本院确诊感染新型冠状病毒(SARS-CoV-2)的COVID-19 重型非ICU患者临床资料.按依诺肝素初始剂量不同分为治疗剂量组和预防剂量组,通过比较 2 组患者接受肝素治疗前后,血小板计数、活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、纤维蛋白原、D二聚体、TEG、hmTEG的参数变化,评估COVID-19 重型非ICU患者接受不同剂量肝素抗凝后凝血功能的变化及出血风险.结果 本研究共纳入 179 名COVID-19 重型非ICU患者,其中治疗剂量组 102 名,预防剂量组 77名.接受肝素抗凝前,除年龄(63.4±11.6 vs 59.8±9.1)D二聚体(678 ng/mL vs 621 ng/mL)和MA值[(69.1±10.2)mm vs(65.6±8.5)mm]外,治疗剂量组血小板计数、活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、纤维蛋白原、R值、K时间、α角、凝血指数(CI),与预防剂量组比较均无统计学差异(P>0.05).接受肝素抗凝后,治疗剂量组与预防剂量组hmTEG检测结果比较,CKR值[(12.2±4.1)min vs(10.2±3.3)min]、CKHR值[(8.1±3.2)min vs(7.1±2.6)min]差异有统计学意义(P<0.05),其余参数组间差异无统计学意义(P>0.05).同时,治疗剂量组与预防剂量组比较,肝素残留或过量比例 15.69％(16/102)vs 5.19％(4/77)显著增加(P<0.05).但 2 组间VTE事件 2.35％(2/85)vs 2.78％(2/72)、消化道出血 2.35％(2/85)vs 1.39％(1/72)、ICU入住 4.71％(4/85)vs 4.17％(3/72)、死亡事件3.53％(3/85)vs 2.78％(2/72)等发生率无差异(P>0.05).结论 在当前COVID-19 流行趋势下,COVID-19 重型非ICU患者血栓预防的肝素初始剂量选择需更为谨慎,为减少出血事件的发生,采用hmTEG对患者进行出血风险的个体化评估,更有利于肝素剂量的调整和控制.
Objective To investigate the clinical application of heparinase-modified TEG(hmTEG)in evaluating coag-ulation status and monitoring anticoagulant therapy in severe non-ICU patients with COVID-19.Methods The clinical data of severe non-ICU patients with COVID-19 confirmed to be infected with novel coronary disease(SARS-CoV-2)from De-cember 2022 to May 2023 were analyzed retrospectively.The patients were divided into therapeutic dose group and prophy-lactic dose group according to the initial dose of enoxaparin.The changes of platelet count,activated partial thromboplastin time,prothrombin time,thrombin time,fibrinogen,D-dimer,TEG and hmTEG before and after heparin treatment were compared between the two groups,so as to evaluate the changes of coagulation function and bleeding risk of COVID-19 se-vere non-ICU patients after anticoagulation with different doses of heparin.Results A total of 179 severe non-ICU patients with COVID-19 were enrolled in this study,including 102 patients in therapeutic dose group and 77 patients in prophylactic dose group.Before receiving heparin anticoagulation,except for age(63.4±11.6 vs 59.8±9.1)D-dimer(678 ng/mL vs 621 ng/mL)and MA values[(69.1±10.2)mm vs(65.6±8.5)mm],there were no statistical differences in platelet count,acti-vated partial thromboplastin time,prothrombin time,thrombin time,fibrinogen,R value,K time,α angle and coagulation index(CI)between the therapeutic dose group and the prophylactic dose group(P>0.05).After receiving heparin antico-agulation,there were significant differences in CKR value[(12.2±4.1)min vs(10.2±3.3)min]and CKHR value[(8.1±3.2)min vs(7.1±2.6)min]between therapeutic dose group and prophylactic dose group(P<0.05),but no significant differ-ences in other parameters between groups(P>0.05).Meanwhile,the proportion of heparin overdose in the therapeutic dose group was significantly higher than that in the prophylactic dose group 15.69％(16/102)vs 5.19％(4/77)(P<0.05).How-ever,there was no difference in the incidence of VTE events 2.35％(2/85)vs 2.78％(2/72),gastrointestinal bleeding 2.35％(2/85)vs 1.39％(1/72),ICU admission 4.71％(4/85)vs 4.17％(3/72)and death events 3.53％(3/85)vs 2.78％(2/72)between the two groups(P>0.05).Conclusion In the current epidemic trend of COVID-19,in order to reduce the occurrence of bleeding events,the heparin dose should be selected more carefully in the prevention of thrombosis in se-vere non-ICU patients with COVID-19.The individualized assessment of bleeding risk by hmTEG is more conducive to the adjustment and control of heparin dose.
钟莹;黄显雯;梁春峰
南宁市第二人民医院 医学检验科/广西分子免疫研究重点实验室,广西 南宁 530031广西中医药大学第一附属医院 医务部广西医科大学第一附属医院 输血科
药学
COVID-19血栓弹力图肝素酶对比试验血栓预防肝素抗凝
COVID-19thromboelastography(TEG)heparinase-modified TEG(hmTEG)thromboprophylaxishepa-rin anticoagulation
《中国输血杂志》 2024 (003)
312-318 / 7
2023年度广西高校中青年教师科研基础能力提升项目(2023KY0085)
评论