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Comparison between unfractionated heparin (UFH) and fondaparinux on platelets and D-dimer level in COVID-19 patients with hypercoagulation
Affiliations- Airlangga University, Indonesia
open access
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.
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.
Keywords
COVID-19; hypercoagulation; unfractionated heparin (UFH); fondaparinux; heparin-induced thrombocytopenia (HIT)
About this articleTitle
Comparison between unfractionated heparin (UFH) and fondaparinux on platelets and D-dimer level in COVID-19 patients with hypercoagulation
Journal
Issue
Article type
Research paper
Pages
161-165
Published online
2022-12-30
Page views
1072
Article views/downloads
96
DOI
10.5603/AA.2022.0015
Bibliographic record
Acta Angiologica 2022;28(4):161-165.
Keywords
COVID-19
hypercoagulation
unfractionated heparin (UFH)
fondaparinux
heparin-induced thrombocytopenia (HIT)
Authors
Meity Ardiana
Hanestya Oky Hermawan
Primasitha Maharany Harsoyo
Inna Maya Sufiyah
Mohammad Fahrizal Fanani
References (20)- 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.
- 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.
- 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.
- 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.
- Arepally GM. Heparin-induced thrombocytopenia. Blood. 2017; 129(21): 2864–2872.
- 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.
- Iba T, Levy JH, Levi M, et al. Coagulopathy of Coronavirus Disease 2019. Crit Care Med. 2020; 48(9): 1358–1364.
- 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.
- Xu P, Zhou Qi, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020; 99(6): 1205–1208.
- 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.
- Wool GD, Miller JL. The Impact of COVID-19 Disease on Platelets and Coagulation. Pathobiology. 2021; 88(1): 15–27.
- Alban S. Adverse Effects of Heparin. Heparin - A Century of Progress. 2011: 211–263.
- Warkentin TE. Fondaparinux for Treatment of Heparin-Induced Thrombocytopenia: Too Good to Be True? J Am Coll Cardiol. 2017; 70(21): 2649–2651.
- Burch M, Cooper B. Fondaparinux-associated heparin-induced thrombocytopenia. Proc (Bayl Univ Med Cent). 2012; 25(1): 13–15.
- Chong BH, Chong JJH. Heparin-induced thrombocytopenia associated with fondaparinux. Clin Adv Hematol Oncol. 2010; 8(1): 63–65.
- Marongiu F, Barcellona D. Fondaparinux: Should It Be Studied in Patients with COVID-19 Disease? TH Open. 2020; 4(4): e300–e302.
- Linkins LA. Heparin induced thrombocytopenia. BMJ. 2015; 350: g7566.
- Negri EM, Piloto BM, Morinaga LK, et al. Heparin Therapy Improving Hypoxia in COVID-19 Patients - A Case Series. Front Physiol. 2020; 11: 573044.
- 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.
- Sholzberg M, Tang GH, Rahhal H, et al. RAPID Trial investigators. Heparin for Moderately Ill Patients with Covid-19. medRxiv. 2021.