Evaluation and analysis of bleeding risk of anticoagulation therapy in severe non-ICU patients with COVID-19 based on heparinase-modified TEG
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.
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