English Polski
Vol 28, No 4 (2022)
Research paper
Published online: 2022-12-30

open access

Page views 3333
Article views/downloads 286
Get Citation

Connect on Social Media

Connect on Social Media

Comparison between unfractionated heparin (UFH) and fondaparinux on platelets and D-dimer level in COVID-19 patients with hypercoagulation

Meity Ardiana1, Hanestya Oky Hermawan1, Primasitha Maharany Harsoyo1, Inna Maya Sufiyah1, Mohammad Fahrizal Fanani1
Acta Angiologica 2022;28(4):161-165.

Abstract

Introduction: This study aimed to compare the clinical effects between UFH and fondaparinux
in COVID-19 patients with hypercoagulation.

Material and methods: This was a prospective cohort study. Samples were taken consecutively from hospitalized
COVID-19 patients with hypercoagulation who received UFH or fondaparinux based on the standardized
guidelines. A total of 71 patients met the inclusion criteria. Patients were evaluated for platelet and D-dimer
values before and after administration of UFH or fondaparinux.

Results: Although there was no difference in D-dimer reduction between the two groups (p = 0.44), fondaparinux
showed a greater reduction, 26% against 22% for UFH. While on platelets, there was a significant
difference (p = 0.04) between fondaparinux and UFH. Fondaparinux showed a reduced thrombocytopenia
impact, as seen by an increase in pre- and post-therapy platelets of up to 50%, compared to 16% in UFH.
In regard to the incidence of Heparin-Induced Thrombocytopenia (HIT), there was no significant difference
between post-UFH therapy and post-fondaparinux therapy (p = 0.361).

Conclusion: Fondaparinux did not reduce platelet levels as much as UFH, but there was no difference
between the fondaparinux group compared to the UFH group in the effect of decreasing D-dimer levels and
the sign of HIT.

Article available in PDF format

View PDF Download PDF file

References

  1. Guan WJ, Ni ZY, Hu Yu, et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18): 1708–1720.
  2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13): 1239–1242.
  3. Malas MB, Naazie IN, Elsayed N, et al. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020; 29: 100639.
  4. Tiwari NR, Khatib KI, Dixit SB, et al. Anticoagulation in COVID - 19: An Update. J Crit Care Med (Targu Mures). 2020; 6(4): 217–223.
  5. Arepally GM. Heparin-induced thrombocytopenia. Blood. 2017; 129(21): 2864–2872.
  6. Kumar P, Mediwake R, Rhead C. A matter of time: duration and choice of venous thromboprophylaxis in patients diagnosed with COVID-19. Br J Hosp Med (Lond). 2020; 81(5): 1–2.
  7. Iba T, Levy JH, Levi M, et al. Coagulopathy of Coronavirus Disease 2019. Crit Care Med. 2020; 48(9): 1358–1364.
  8. Chan JFW, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020; 395(10223): 514–523.
  9. Xu P, Zhou Qi, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020; 99(6): 1205–1208.
  10. Güçlü E, Kocayiğit H, Okan HD, et al. Effect of COVID-19 on platelet count and its indices. Rev Assoc Med Bras (1992). 2020; 66(8): 1122–1127.
  11. Wool GD, Miller JL. The Impact of COVID-19 Disease on Platelets and Coagulation. Pathobiology. 2021; 88(1): 15–27.
  12. Alban S. Adverse Effects of Heparin. Heparin - A Century of Progress. 2011: 211–263.
  13. Warkentin TE. Fondaparinux for Treatment of Heparin-Induced Thrombocytopenia: Too Good to Be True? J Am Coll Cardiol. 2017; 70(21): 2649–2651.
  14. Burch M, Cooper B. Fondaparinux-associated heparin-induced thrombocytopenia. Proc (Bayl Univ Med Cent). 2012; 25(1): 13–15.
  15. Chong BH, Chong JJH. Heparin-induced thrombocytopenia associated with fondaparinux. Clin Adv Hematol Oncol. 2010; 8(1): 63–65.
  16. Marongiu F, Barcellona D. Fondaparinux: Should It Be Studied in Patients with COVID-19 Disease? TH Open. 2020; 4(4): e300–e302.
  17. Linkins LA. Heparin induced thrombocytopenia. BMJ. 2015; 350: g7566.
  18. Negri EM, Piloto BM, Morinaga LK, et al. Heparin Therapy Improving Hypoxia in COVID-19 Patients - A Case Series. Front Physiol. 2020; 11: 573044.
  19. Lazaridis D, Leung S, Kohler L, et al. The Impact of Anticoagulation on COVID-19 (SARS CoV-2) Patient Outcomes: A Systematic Review. J Pharm Pract. 2022; 35(6): 1000–1006.
  20. Sholzberg M, Tang GH, Rahhal H, et al. RAPID Trial investigators. Heparin for Moderately Ill Patients with Covid-19. medRxiv. 2021.