Elevated eosinophil count is related with lower anti-factor Xa activity in COVID-19 patients
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ORIGINAL ARTICLE
Elevated eosinophil count is related with lower anti-factor Xa activity in COVID-19 patients Selma Ari 1 & Veysi Can 1 & Ömer Furkan Demir 1 & Hasan Ari 1 & Fahriye Vatansever Ağca 1 & Mehmet Melek 1 & Sencer Çamci 1 & Özlem Şengören Dikiş 2 & Kağan Huysal 3 & Tamer Türk 4 Received: 17 August 2020 / Accepted: 30 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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). Keywords COVID-19 . Eosinophils . Heparin . Anticoagulants . Thrombosis
Introduction Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID19), which has been considered a pandemic by the World * Hasan Ari [email protected] 1
Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
2
Department of Pulmonary Diseases, Bursa Postgraduate Hospital, Bursa, Turkey
3
Department of Biochemistry, Bursa Postgraduate Hospital, Bursa, Turkey
4
Department of Cardiovascular Surgery, Bursa Postgraduate Hospital, Bursa, Turkey
Health Organization (WHO) [1, 2]. Several reports have shown that, simil
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