Antitrombotik İlaçların COVID-19 Şiddeti Üzerindeki Profilaktik Etkisi; Retrospektif Gözlemsel Çalışma

Year 2022, , 74 - 77, 30.06.2022

Ejder Saylav Bora , Adnan Yamanoğlu , Guner Yurtsever , Nalan Gökçe Çelebi Yamanoğlu , Hüseyin Acar , Cüneyt Arıkan , Fatih Topal

https://doi.org/10.54996/anatolianjem.1023737

Abstract

Amaç: Antitrombotik ilaçlar ağır COVID-19 hastalarının tedavisinde kendine rutin bir yer edinmiş olmasına rağmen, enfeksiyona maruz kalmadan önce herhangi bir sebeple antitrombotik ilaç kullanımının hastalığın prognozuna ve klinik seyrine bir etkisi olup olmadığı henüz bilinmemektedir. Bu çalışmanın amacı SARS COV-2’ye maruz kalmadan önce antitrombotik ilaç kullanımının hastalığın klinik seyri ve mortalitesi üzerine etkisi olup olmadığını belirlemektir.

Gereç ve Yöntemler: Hastanemiz COVID-19 polikliniğine başvuran COVID-19 tanısı yapılan RT-qPCR test sonucu ile doğrulanan ve bir akciğer görüntülemesi ile COVID-19 pnömonisi tanısı alan tüm hastalar çalışmaya dahil edilmiştir. Covid-19 pnömonisi olan hastaların anamnez bilgileri, hastanede ve yoğun bakımda yatış süreleri hastane kayıt sisteminden elde edildi ve kayıt altına alındı. Tüm hastaların klinik sonlanımları; sağkalım veya exitus olarak sınıflandırılarak kayıt altına alındı.

Bulgular: PCR testi pozitif olup aynı zamanda viral pnömonisi olan hasta sayısı toplam 415 idi. Hastaların yaş ortalaması 53±19 ve 234’ü (56%) erkek idi. 415 hastanın 168’i (40%) en az bir çeşit antitrombotik ilaç kullanmakta iken 247’si (60%) herhangi bir antitrombotik ilaç kullanmıyordu. COVID-19 öncesi antitrombotik ilaç kullanan 168 hastada mortalite oranı %4,5 iken, antitrombotik kullanmayan 247 hastada mortalite oranı %12,5 olarak bulundu (p=0.008). Antitrombotik ilaç kullanan 168 hastada yoğun bakıma yatış oranı %10,1 iken, antitrombotik kullanmayan 247 hastada yoğun bakıma yatış oranı %13,7 olarak (p=0.31).

Sonuç: Erken hastalıkta, özellikle ayaktan hastalarda antitrombotik tedavi, koagülopatiyi ve endotelyal ilişkili hastalığı önleyebilir, ancak trombo-inflamatuar faz sırasında çok geç bir antitrombotik tedavi uygulaması gerekli koruyucu etkiyi sağlamayabilir. Bu hipotezin uygun prospektif randomize çalışmalarda test edilmesi gerekmektedir.

Keywords

Acil tıp, antitrombotik ilaçlar, COVID-19, profilaksi

Prophylactic Effect of Antithrombotic Drugs on the Severity of COVID-19; Retrospective Observational Study

Abstract

Aim: Although antithrombotic drugs have a routine place in the treatment of severe COVID-19 patients, it is not yet known whether the use of antithrombotic drugs for any reason before exposure to infection has an effect on the prognosis and clinical course of the disease. The aim of this study is to determine whether the use of antithrombotic drugs before exposure to SARS COV-2 has an effect on the clinical course and mortality of the disease.

Material and Methods: All patients who were admitted to our hospital's COVID-19 outpatient clinic, diagnosed with COVID-19, confirmed by RT-qPCR test results, and diagnosed with COVID-19 pneumonia with a lung imaging were included in the study. Anamnesis information of patients with Covid-19 pneumonia, length of stay in hospital and intensive care unit were obtained and recorded in the hospital registry system. Clinical outcomes of all patients were recorded as survival or exitus.

Results: The total number of patients with a positive PCR test result and viral pneumonia was 415. The mean age of the patients was 53 ±19 and 234 (56%) were male. While 168 (40%) of 415 patients were using at least one type of antithrombotic drug, 247 (60%) were not using any antithrombotic drug. While the mortality rate was 4.5% in 168 patients who used antithrombotic drugs before COVID-19, the mortality rate was 12.5% in 247 patients who did not use antithrombotic drugs (p= 0.008). While the rate of hospitalization in the intensive care unit was 10.1% in 168 patients who used antithrombotic drugs, the rate of intensive care was 13.7% in 247 patients who did not use antithrombotic drugs (p= 0.31).

Conclusion: Antithrombotic therapy in early disease, especially in outpatients, may prevent coagulopathy and endothelial-associated disease, but administration of antithrombotic therapy too late during the thrombo-inflammatory phase may not provide the necessary protective effect. This hypothesis needs to be tested in appropriate prospective randomized trials.

Keywords

Emergency medicine, antithrombotic drugs, COVID-19, prophylaxis

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