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Elevated eosinophil count is related with lower anti-factor Xa activity in COVID-19 patients
Selma Ari1, Veysi Can1, Ömer Furkan Demir1
1Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
Insights
Elevated eosinophil counts are linked to lower anti-factor Xa activity in COVID-19 patients on low molecular weight heparin (LMWH). Further research is needed to understand the clinical implications of subprophylactic anticoagulation in these patients.
Area of Science:
- Hematology
- Infectious Diseases
- Pharmacology
Background:
- Thrombotic complications remain a risk for COVID-19 patients despite anticoagulant therapy.
- Low molecular weight heparin (LMWH) is commonly used for prophylaxis in these patients.
- Understanding factors affecting LMWH efficacy is crucial for optimizing treatment.
Purpose of the Study:
- To investigate factors influencing anti-factor Xa activity in COVID-19 patients receiving LMWH.
- To identify predictors of subprophylactic anti-factor Xa activity.
Main Methods:
- Prospective evaluation of 80 COVID-19 patients receiving LMWH (enoxaparin).
- Measurement of anti-factor Xa activity 4 hours after the 3rd LMWH dose.
- Analysis of clinical data, including eosinophil proportion and D-dimer levels.
Main Results:
- A significant association was found between elevated eosinophil counts and lower anti-factor Xa activity (< 0.2 IU/mL).
- Patients with subprophylactic activity had higher eosinophil proportions at discharge.
- ROC analysis indicated eosinophil count as a potential predictor of subprophylactic anticoagulation.
Conclusions:
- Elevated eosinophil count is related to reduced anti-factor Xa activity in COVID-19 patients on LMWH.
- The clinical significance of subprophylactic anti-factor Xa activity warrants further investigation.
- This finding may inform personalized anticoagulation strategies for COVID-19 patients.
Abstract:
Despite prophylactic anticoagulant treatments, thrombotic complications may develop in patients with coronavirus disease 2019 (COVID-19). This study aimed to evaluate the factors influencing anti-factor Xa activity in COVID-19 patients receiving low molecular weight heparin (LMWH). We prospectively evaluated 80 COVID-19 patients, diagnosed using polymerase chain reaction test, who were admitted to our clinic and administered LMWH; LMWH (enoxaparin) was applied according to the weight, D-dimer levels, and clinical condition of patients. Anti-factor Xa activity in blood, drawn 4 h after the 3rd dose of LMWH, was measured and an activity of < 0.2 IU/mL was considered subprophylactic. Patients were followed up clinically, and anti-factor Xa activity was re-examined before discharge. Groups 1 and 2 included 13 and 67 patients with subprophylactic (mean ± SD: 0.18 ± 0.06) and prophylactic (mean ± SD: 0.43 ± 0.23) anti-factor Xa activity, respectively. The proportion of eosinophils in patients was significantly higher in group 1 than in group 2 (mean ± SD; 2.96 ± 2.55 vs 0.90 ± 1.28; p = 0.001). At the time of discharge, the eosinophilic proportion of patients was significantly higher (eosinophil %, mean ± SD; 3.06 ± 1.49 vs 2.07 ± 1.92; p = 0.001), but the activated partial thromboplastin time was significantly lower (22.34 ± 1.38 vs 24.38 ± 3.58; p = 0.01) in group 1 than in group 2. Of 14 patients with eosinophil content > 4%, 6 were in group 1 ((6/13) 46.2%), while 8 were in group 2 ((8/63) 11.9%); (p = 0.009), and all had a D-dimer level < 1 μg/mL (p = 0.03). ROC analysis for the presence of anticoagulation at subprophylactic level revealed an area under curve of 0.79 (95% CI: 0.64-0.93); p = 0.001). In conclusion; Elevated eosinophil count is related to lower anti-factor Xa activity in patients with COVID-19 receiving LMWH. The clinical significance of the subprophylactic anti-factor Xa activity should be studied in COVID-19 patients (NCT04507282).
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