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Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia

Critically ill patients with COVID-19 are at an increased thrombotic risk, hence thromboprophylaxis with heparin is considered mandatory. Antithrombin III (ATIII) is the most potent endogenous anticoagulant and is required for the clinical efficacy of heparin. Profound hypercoagulable and inflammato...

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Autores principales: Joshi, Deepti, Manohar, Sarat, Goel, Garima, Saigal, Saurabh, Pakhare, Abhijit P, Goyal, Abhishek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8570439/
https://www.ncbi.nlm.nih.gov/pubmed/34754684
http://dx.doi.org/10.7759/cureus.18538
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author Joshi, Deepti
Manohar, Sarat
Goel, Garima
Saigal, Saurabh
Pakhare, Abhijit P
Goyal, Abhishek
author_facet Joshi, Deepti
Manohar, Sarat
Goel, Garima
Saigal, Saurabh
Pakhare, Abhijit P
Goyal, Abhishek
author_sort Joshi, Deepti
collection PubMed
description Critically ill patients with COVID-19 are at an increased thrombotic risk, hence thromboprophylaxis with heparin is considered mandatory. Antithrombin III (ATIII) is the most potent endogenous anticoagulant and is required for the clinical efficacy of heparin. Profound hypercoagulable and inflammatory state associated with COVID-19 can result in decreased ATIII levels and ineffective heparin treatment resulting in increased mortality. The present study evaluated ATIII levels in critically ill patients of COVID-19 and correlated them with other coagulation parameters and disease outcomes. A retrospective review of those critically ill COVID-19 patients was performed who were on a therapeutic dose of low molecular weight heparin (LMWH) and had serial measurements of ATIII, anti-factor Xa (antiFXa) assay and other routine coagulation parameters. A total of 27 critically ill COVID-19 patients were identified, out of these, 12 survived and 15 had disease-induced mortality. ATIII levels were found to be significantly lower in non-survivors on the third day of serial measurement along with worsening of other coagulation parameters. AntiFXa levels were found to be higher in non-survivors as compared to survivors. Further studies are required to establish ATIII as a prognostic marker and to determine the utility of monitoring antiFXa levels in COVID-19 patients on LMWH therapy.
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spelling pubmed-85704392021-11-08 Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia Joshi, Deepti Manohar, Sarat Goel, Garima Saigal, Saurabh Pakhare, Abhijit P Goyal, Abhishek Cureus Infectious Disease Critically ill patients with COVID-19 are at an increased thrombotic risk, hence thromboprophylaxis with heparin is considered mandatory. Antithrombin III (ATIII) is the most potent endogenous anticoagulant and is required for the clinical efficacy of heparin. Profound hypercoagulable and inflammatory state associated with COVID-19 can result in decreased ATIII levels and ineffective heparin treatment resulting in increased mortality. The present study evaluated ATIII levels in critically ill patients of COVID-19 and correlated them with other coagulation parameters and disease outcomes. A retrospective review of those critically ill COVID-19 patients was performed who were on a therapeutic dose of low molecular weight heparin (LMWH) and had serial measurements of ATIII, anti-factor Xa (antiFXa) assay and other routine coagulation parameters. A total of 27 critically ill COVID-19 patients were identified, out of these, 12 survived and 15 had disease-induced mortality. ATIII levels were found to be significantly lower in non-survivors on the third day of serial measurement along with worsening of other coagulation parameters. AntiFXa levels were found to be higher in non-survivors as compared to survivors. Further studies are required to establish ATIII as a prognostic marker and to determine the utility of monitoring antiFXa levels in COVID-19 patients on LMWH therapy. Cureus 2021-10-06 /pmc/articles/PMC8570439/ /pubmed/34754684 http://dx.doi.org/10.7759/cureus.18538 Text en Copyright © 2021, Joshi et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Infectious Disease
Joshi, Deepti
Manohar, Sarat
Goel, Garima
Saigal, Saurabh
Pakhare, Abhijit P
Goyal, Abhishek
Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia
title Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia
title_full Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia
title_fullStr Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia
title_full_unstemmed Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia
title_short Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia
title_sort adequate antithrombin iii level predicts survival in severe covid-19 pneumonia
topic Infectious Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8570439/
https://www.ncbi.nlm.nih.gov/pubmed/34754684
http://dx.doi.org/10.7759/cureus.18538
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