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Research ArticleOriginal Article
Open Access

The effect of low-dose and high-dose low-molecular-weight-heparin and aspirin thromboprophylaxis on clinical outcome and mortality in critical ill patients with COVID-19

A retrospective cohort study

Ali Eman, Onur Balaban, Kezban Ö. Süner, Yaşar Cırdı, Fatih Şahin, Gürkan Demir, Özge Pekşen, Ahmet Musmul and Ali F. Erdem
Saudi Medical Journal July 2022, 43 (7) 715-722; DOI: https://doi.org/10.15537/smj.2022.43.7.20220038
Ali Eman
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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Onur Balaban
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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Kezban Ö. Süner
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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Yaşar Cırdı
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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Fatih Şahin
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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  • For correspondence: [email protected]
Gürkan Demir
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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Özge Pekşen
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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Ahmet Musmul
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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Ali F. Erdem
From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey.
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    Figure 1

    - Laboratory values on the first and seventh days. CRP: C-reactive protein, eGFR: estimated glomerular filtration rate

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    Table 1

    - Data of demographic characteristics, comorbidities and symptoms during the admission to the intensive care unit (N=164).

    VariablesGroup A (n=45)Group B (n=26)Group C (n=93)P-values
    Age (year), mean±SD68.64±15.0466.77±12.8869.72±11.070.564
    Gender: male/female (n)26/1918/868/250.191
    BMI (kg/m2), mean±SD26.87±5.7226.56±7.3027.32±3.370.213
    Comorbidities, n (%)
    COPD10 (22.2)6 (23.1)12 (12.9)0.266
    Coronary disease5 (11.1)4 (15.4)11 (11.8)0.857
    Heart failure4 (8.9)4 (15.4)12 (12.9)0.687
    Diabetes14 (31.1)11 (42.3)23 (24.7)0.209
    Hypertension18 (40.0)13 (50.0)43 (46.2)0.679
    Chronic renal failure2 (4.4)2 (7.7)4 (4.3)0.871
    Malignant neoplasm3 (6.7)2 (7.7)15 (16.1)0.210
    Symptoms, n (%)
    Fever11 (24.4)1 (3.8)15 (16.1)0.780
    Cough12 (26.7)5 (19.2)29 (31.2)0.473
    Dyspnea35 (77.8)25 (96.2)78 (83.9)0.123
    GI2 (4.4)0 (0)8 (8.6)0.223
    Widespread pain4 (8.9)3 (11.5)13 (14)0.689
    Weakness11 (24.4)10 (38.5)32 (34.4)0.385
    Tachypnea33 (73.3)15 (57.7)44 (47.3)0.015*
    • ↵* p<0.05, COPD: chronic obstructive pulmonary disease, BMI: body mass index, GI: gastrointestinal, SD: standard diviation

    • View popup
    Table 2

    - Comparison of groups regarding the method of oxygen supplement therapy (N=164).

    Oxygen supplement modalityGroup A (n=45)Group B (n=26)Group C n=93)P-values
    Oxygen mask with reservoir20 (44.4)9 (34.6)45 (48.4)0.457
    High-flow nasal cannula4 (8.9)1 (3.8)19 (20.4)0.047*
    NIPPV3 (6.7)2 (7.7)21 (22.6)0.026*
    IPPV37 (82.2)24 (92.3)83 (89.2)0.371
    • ↵* p<0.05, NIPPV: noninvasive positive pressure ventilation, IPPV: invasive positive pressure ventilation

    • View popup
    Table 3

    - Comparison of intensive care follow-up data between groups (N=164).

    Intensive care follow-up dataGroup A (n=45)Group B (n=26)Group C (n=93)P-values
    Number of total days in ICU median (IQR)13 (9-24.5)11 (8.75-23)13 (9-17)0.547
    Time until discharge of patients that survived from ICU (days) median (IQR)14.5 (8.75-33)23 (13.25-32.75)12 (7.5-27)0.692
    Number of days IPPV applied, median (IQR)11 (9-18,5)9 (5.5-16)10 (6-15)0.066
    Time until death of patients in ICU (days) median (IQR)13 (9-23)10.5 (8-14)13.5 (9-16.75)0.381
    Hemorrhage requiring transfusion n (%)9 (20.0)5 (19.2)13 (14.0)0.615
    Thrombotic event n (%)3 (6.7)4 (15.4)10 (10.8)0.565
    Mortality rate (%)77.884.690.30.135

    ICU: intensive care unit, IPPV: invasive positive pressure ventilation, IQR: interquartile range

      • View popup
      Table 4

      - Data of laboratory tests compared between groups. The values are given as median (IQR) obtained on 1st day / 7th day in intensive care (N=164).

      Variables (normal range)Group A(n=45)Group B(n=26)Group C(n=93)P-values
      Creatinine (0.51-0.95 mg/dl)1.12 (0.74-1.9)/1.3 (0.63-2.3)0.97 (0.7-1.58)/0,97 (0.62-1.92)1 (0.71-1.43)/1,02 (0.69-1.88)0.652/0.725
      EGFR (>90 mL/dk)49 (30.5-87.03)/42,43 (21.04-94.5)75 (35.15-89.37)/66.69 (31.5-97.42)71 (42.97-95)/71.9 (30.55-97.020.226/0.470
      D-dimer (0-500 ugFEU/L)1390 (629-2820)/2430 (1285-8270)1605 (1030-2902,5)/2035 (1104-6145)1660 (708-3700)/2730 (1575-6300)0.592/0.591
      CRP (0-5 mg/L)122 (44.5-156.5)/121 (68.9-196.5)134.5 (53.15-180.75)/117 (56.78-168.5)135 (56.80-190)/104 (51-173)0.436/0.437
      Ferritin (5-204 mcg/L)469 (169.44-1130)/567 (302.36-1393)716.21 (246-1476)/742.49 (425-1859)1005 (490-1844)/871 (578.5-1418)0.002*/0.064
      Procalcitonin (<0.5 ng/ml)0,31 (0.16-2.04)/0,70 (0.29-3.26)0,48 (0.29-3.47)/0,76 (0.31-4.13)0,40 (0.17-1.29)/0,66 (0.25-2.65)0.408/0.735
      Leukocyte(4.6-10.2 K/uL)9.04 (7-13.5)/12 (8.97-18)6.75 (4.82-10.46)/10.9 (6-13.25)11 (7.71-15.15)/14 (10.05-19.6)0.005*/0.005*
      Hematocrit (37.7-53.7%)37 (33.75-42)/31 (27.2-36)38 (33.13-43)/32,05 (27.75-36)39 (35-43)/34 (29.7-39)0.282/0.012*
      Thrombocyte (142-424 K/uL)202 (154-284.5)/209 (131-265)161,5 (126-226)/160,50 (115-214)231 (173-297)/203 (136-276)0.003*/0.247
      Lymphocyte (0.60-3.4 K/uL)0.77 (0.49-1.21)/0.6 (0.49-1.03)0.62 (0.49-1.03)/0.6 (0.46-1.32)0.61 (0.39-0.99)/0.52 (0.29-0.92)0.149/0.073
      • ↵* p<0.05, EGFR: Estimated glomerular filtration rate, CRP: C reactive protein, IQR: interquartile range. These values have also been expressed in Figure 1.

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    The effect of low-dose and high-dose low-molecular-weight-heparin and aspirin thromboprophylaxis on clinical outcome and mortality in critical ill patients with COVID-19
    Ali Eman, Onur Balaban, Kezban Ö. Süner, Yaşar Cırdı, Fatih Şahin, Gürkan Demir, Özge Pekşen, Ahmet Musmul, Ali F. Erdem
    Saudi Medical Journal Jul 2022, 43 (7) 715-722; DOI: 10.15537/smj.2022.43.7.20220038

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    The effect of low-dose and high-dose low-molecular-weight-heparin and aspirin thromboprophylaxis on clinical outcome and mortality in critical ill patients with COVID-19
    Ali Eman, Onur Balaban, Kezban Ö. Süner, Yaşar Cırdı, Fatih Şahin, Gürkan Demir, Özge Pekşen, Ahmet Musmul, Ali F. Erdem
    Saudi Medical Journal Jul 2022, 43 (7) 715-722; DOI: 10.15537/smj.2022.43.7.20220038
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    Keywords

    • COVID-19
    • critical illness
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