Platelet Count Rose While D-Dimer Levels Dropped as Deaths and Thrombosis Declined—An Observational Study on Anticoagulation Shift in COVID-19

Anna Sjöström; Johanna Dehlsen Wersäll; Anna Warnqvist; Maria Farm; Maria Magnusson; Anders Oldner; Anna Ågren; Jovan Antovic; Maria Bruzelius

doi:10.1055/a-1477-3829

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2021; 121(12): 1610-1621
DOI: 10.1055/a-1477-3829

Coagulation and Fibrinolysis

Platelet Count Rose While D-Dimer Levels Dropped as Deaths and Thrombosis Declined—An Observational Study on Anticoagulation Shift in COVID-19

Anna Sjöström

¹Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

²Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden

,

Johanna Dehlsen Wersäll

²Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden

,

Anna Warnqvist

³Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

,

Maria Farm

¹Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

²Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden

,

Maria Magnusson

¹Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

⁴Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

⁵Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden

,

Anders Oldner

⁶Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

⁷Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden

,

Anna Ågren

¹Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

⁵Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden

⁸Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

,

Jovan Antovic

¹Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

²Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden

,

Maria Bruzelius

¹Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

⁵Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden

⁹Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden

› Institutsangaben

Abstract

Background High levels of D-dimer and low platelet counts are associated with poor outcome in coronavirus disease 2019 (COVID-19). As anticoagulation appeared to improve survival, hospital-wide recommendations regarding higher doses of anticoagulation were implemented on April 9, 2020.

Objectives To investigate if trends in D-dimer levels and platelet counts were associated with death, thrombosis, and the shift in anticoagulation.

Methods Retrospective cohort study of 429 patients with COVID-19 at Karolinska University Hospital. Information on D-dimer levels and platelet counts was obtained from laboratory databases and clinical data from medical records.

Results Thirty-day mortality and thrombosis rates were 19% and 18%, respectively. Pulmonary embolism was common, 65/83 (78%). Increased D-dimer levels in the first week in hospital were significantly associated with death and thrombosis (odds ratio [OR]: 6.06; 95% confidence interval [CL]: 2.10–17.5 and 3.11; 95% CI: 1.20–8.10, respectively). If platelet count increased more than 35 × 10⁹/L per day, the mortality and thrombotic risk decreased (OR: 0.16; 95% CI: 0.06–0.41, and OR: 0.36; 95% CI: 0.17–0.80). After implementation of updated hospital-wide recommendations, the daily mean significantly decreased regarding D-dimer levels while platelet counts rose; −1.93; 95% CI: −1.00–2.87 mg/L FEU (fibrinogen-equivalent unit) and 65; 95% CI: 54–76 ×10⁹/L, and significant risk reductions for death and thrombosis were observed; OR: 0.48; 95% CI: 0.25–0.92 and 0.35; 95% CI: 0.17–0.72.

Conclusion In contrast to D-dimer levels, increase of platelet count over the first week in hospital was associated with improved survival and reduced thrombotic risk. The daily mean levels of D-dimer dropped while the platelet counts rose, coinciding with increased anticoagulation and a decline in thrombotic burden and mortality.

Keywords

COVID-19 - platelet count - thrombosis - low-molecular-weight heparin

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