Antikoagülan Tedavi ve COVID-19

Öz

Giriş ve Amaç: Bu çalışmada, atriyal fibrilasyonun (AF) COVID-19 hastalarında mortaliteye etkisini ve riskli AF hastalarının belirlenmesinde kullanılabilicek risk skorlarını incelemeyi amaçladık. Bunun yanında oral antikoagülan kullanımın tedavideki yerini incelemeyi amaçladık. Gereç ve Yöntemler: COVID-19 tanısı almış hastaların kayıtları retrospektif olarak incelendi. Bu hastalar içinden AF tanısı olan 48 hasta belirlendi. Hastaların yoğun bakım ihtiyacı, mortalitesi, CHA2DS2VASC ve HAS-BLED skorları kaydedildi. CRP ve D-Dimer düzeyleri kaydedildi. Hastaların kullanmış oldukları oral antikoagülan tedaviler kayıt altına alındı. Bulgular: Yoğun bakım ünitesinde takip edilen hastaların CHA2DS2VASC (yoğun bakım: 4,50±1,41, dahiliye servisi: 2,50±1,05, p<0,05) ve HAS-BLED (yoğun bakım: 2,0±1,08, dahiliye servisi: 1,5±0,77, p<0,05) skorları daha yüksekti. Hayatını kaybeden atriyal fibrilasyonlu hastalar daha yüksek CRP (hayatta kalan: 21,50 ± 15,23, hayatta kalmayan: 142,30 ± 48,49, p <0,05) ve D-Dimer (hayatta kalan: 183,47 ± 43,68, hayatta kalmayan: 878,98 ± 112,24, p <0,05) değerlerine sahipti. Hastaların 24’ü kullanmış olduğu oral antikoagülana devam ederken 24’ü düşük molekül ağrlıklı heparin (DMAH) kullanmış. Bu hastaların hiçbirinde kanama saptanmadı. Eritrosit replasmanı gerektiren anemi iki grup arasında benzerdi (oral antikoaülan: 2 (8,3%), DMAH: 3 (12,5%), p:0,152). Mortalite her iki grup arasında benzerdi (oral antikoaülan: 5 (20,8%), DMAH: 5 (20,8%), p:0,248). Sonuç: AF, COVID-19'da mortaliteyi etkileyen önemli bir kardiyovasküler risk faktörüdür. Riskli hastaların belirlenmesinde CHA2DS2VASC ve HAS-BLED skorları önemlidir. CRP ve D-Dimer, riskli AF hastalarının belirlenmesinde önemli laboratuvar parametreleridir. Hastaların kullanmış oldukları antikoagülan tedaviler COVID-19 tedavisinde önerilen DMAH yerine düşünülebilir.

Anahtar Kelimeler

• Atriyal fibrilasyon
• COVID-19
• CHA2DS2VASC
• HAS-BLED
• antikoagülan tedavi

Anticoagulant treatment and COVID-19

Öz

Objective: In this study, we aimed to examine the effect of atrial fibrillation (AF) on mortality in COVID-19 patients and the risk scores that can be used in determining risky AF patients. In addition, we aimed to examine the place of oral anticoagulant use in treatment. Materials and Methods: Records of patients diagnosed with COVID-19 were retrospectively reviewed. Among these patients, 48 patients with a diagnosis of AF were identified. Intensive care need, mortality, CHA2DS2VASC and HAS-BLED scores of the patients were recorded. CRP and D-Dimer levels were recorded. Oral anticoagulant treatments used by the patients were recorded. Results: The CHA2DS2VASC (intensive care: 4,50±1,41, internal medicine service: 2,50±1,05, p<0,05) and HAS-BLED (intensive care: 2,0±1,08, internal medicine service: 1,5±0,77, p<0,05) scores of the patients followed in the intensive care unit were higher. Non-Survivor Patients with atrial fibrillation had higher CRP (survivor: 21,50±15,23, non-survivor: 142,30±48,49, p<0,05) and D-Dimer (survivor: 183,47±43,68, non-survivor: 878,98±112,24, p<0,05) values. While 24 of the patients continued their oral anticoagulant use, 24 of them used low molecular weight heparin (LMWH). No bleeding was detected in any of these patients. Anemia requiring erythrocyte replacement was similarbetween the two groups (oral anticoagulant: 2 (8,3%), LMWH: 3 (12,5%), p:0,152). Mortality was similar between both groups (oral anticoagulant: 5 (20,8%), LMWH: 5 (20,8%), p: 0,248). Conclusion: AF is an important cardiovascular risk factor affecting mortality in COVID-19. CHA2DS2VASC and HAS-BLED scores are important in determining patients at risk. CRP and D-Dimer are important laboratory parameters in determining risky AF patients. Anticoagulant treatments used by patients can be considered instead of LMWH recommended in the treatment of COVID-19.

Anahtar Kelimeler

• Atrial Fibrillation
• COVID-19
• CHA2DS2VASC
• HAS-BLED
• anticoagulant treatment

Kaynakça

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