ASSOCIATION OF COAGULATION DYSFUNCTION WITH CARDIAC INJURY IN HOSPITALIZED PATIENTS WITH COVID-19
Main Article Content
Keywords
COVID-19, Cardiac Injury, Coagulation Dysfunction
Abstract
Objective: To determine the association of coagulation dysfunction with cardiac injury in hospitalized patients with COVID-19.
Study Design: Descriptive Cross Sectional.
Place and Duration of Study: Department of Hematology, MTI-HayatabadMedical Complex, Peshawar, from Jun 2021 to Dec 2021.
Methodology: A total of 103 patients hospitalized for COVID-19 were included in this study. The sample size was calculated by WHO Sample Size calculator with 7.20% proportion of cardiac injury in hospitalized COVID-19 patients, 5% margin of error and 5% significance level. Cardiac and coagulation biomarkers were recorded at the time of admission and later during hospitalization. To establish association between coagulation dysfunction and cardiac injury, spearman correlation coefficient was used.
Results: Mean age of patients was 57.6+12.36 years. Mean d-dimer was 2.022+2.84 ug/mL, mean fibrin levels were 34.27+54.68 mg/dL and mean fibrinogen was 2.51+1.04 g/L, mean hsTn1 was 5.88+6.51 pg/mL, mean myohemoglobin was 65.49+52.2 ng/mL and mean CK-MB was 16.76+6.67 U/L. Cardiac injury was recorded in 23 (22.3%) patients hospitalized due to COVID-19.
Conclusion: This study demonstrated a significant association of coagulation dysfunction with the development of cardiac injury as markers of coagulation function were found significantly synchronized with the dynamic progression of cardiac biomarkers.
References
2. Chen L, Hu W, Guo X, Zhao P, Tang J, Gu Y, et al. Association of coagulation dysfunction with cardiac injury among hospitalized patients with COVID-19. Sci Rep. 2021 Feb 24;11(1):4432.
3. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. World Health Organization; 2013.
4. Witt BJ, Gami AS, Ballman KV, et al. The incidence of ischemic stroke in chronic heart failure: a meta-analysis. J Card Fail. 2007;13(6):489–496.
5. Guo T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020;5:811–818.doi: 10.1001/jamacardio.2020.1017.
6. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS- CoV-2. Cardiovasc. Res. 2020;116:1097– 1100. doi: 10.1093/cvr/cvaa078.
7. Nicin L. Cell type-specific expression of the putative SARS-CoV-2 receptor ACE2 in human hearts. Eur. Heart J. 2020;41:1804– 1806. doi: 10.1093/eurheartj/ehaa311.
8. Hoffmann M. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181:271–280. doi: 10.1016/j.cell.2020.02.052.
9. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat. Rev. Cardiol. 2020;17:259–260. doi: 10.1038/s41569-020-0360-5.
10. Shi S. Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019. Eur. Heart J. 2020;41:2070–2079.doi: 10.1093/eurheartj/ehaa408.
11. Chen T. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study. BMJ. 2020;368:m1091. doi: 10.1136/bmj.m1091.
12. Sama IE. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors. Eur. Heart J. 2020;41:1810– 1817. doi: 10.1093/eurheartj/ehaa373.
13. Cao W, Li T. COVID-19: Towards understanding of pathogenesis. CellRes. 2020;30:367–369. doi: 10.1038/s41422-020-0327-4.
14. Bikdeli B. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up. J. Am. Coll. Cardiol. 2020;75:2950–2973
15. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb. Haemost. 2020;18:844–847. doi: 10.1111/jth.14768.
16. Varga Z. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395:1417–1418. doi: 10.1016/S0140-6736(20)30937-5.
17. Paranjpe I. Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. J. Am. Coll. Cardiol. 2020;76:122–124. doi: 10.1016/j.jacc.2020.05.001.
18. Nadkarni GN, et al. Anticoagulation, bleeding, mortality, and pathology in hospitalized patients with COVID-19. J. Am. Coll. Cardiol. 2020;76:1815–1826. doi: 10.1016/j.jacc.2020.08.041.
19. Ayerbe L, Risco C, Ayis S. The association between treatment with heparin and survival in patients with Covid-19. J. Thromb. Thrombolysis. 2020;50:298–301.doi: 10.1007/s11239-020-02162-z.
20. Billett HH. Anticoagulation in COVID-19: Effect of enoxaparin, heparin, and apixaban on mortality. Thromb. Haemost. 2020 doi: 10.1055/s-0040-1720978.
21. Tang N. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with oagulopathy. J. Thromb. Haemost. 2020;18:1094–1099. doi: 10.1111/jth.14817.
22. Bikdeli B, et al. Intermediate versus standard-dose prophylactic anticoagulation and statin therapy versus placebo in critically-ill patients with COVID-19: Rationale and design of the INSPIRATION/INSPIRATION-S studies. Thromb. Res. 2020;196:382–394. doi: 10.1016/j.thromres.2020.09.027.
23. Busani S. Multi-centre, three arm, randomized controlled trial on the use of methylprednisolone and unfractionated heparin in critically ill ventilated patients with pneumonia from SARS-CoV-2 infection: A structured summary of a study protocol for a randomised controlled trial. Trials. 2020;21:724. doi: 10.1186/s13063-020-04645-z.
24. Houston BL. Anti-thrombotic therapy to ameliorate complications of COVID-19 (ATTACC): Study design and methodology for an international, adaptive Bayesian randomized controlled trial. Clin. Trials. 2020;17:491–500. doi: 10.1177/1740774520943846.
25. Lemos ACB. Therapeutic versus prophylactic anticoagulation for severe COVID-19: A randomized phase II clinical trial (HESACOVID) Thromb. Res. 2020;196:359–366. doi: 10.1016/j.thromres.2020.09.026.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Muizz Zahoor
PG Trainee, Department of Cardiology, MTI-Hayatabad Medical Complex, Peshawar, Pakistan
Muhammad Shoaib
PG Trainee, Department of Haematology, MTI-Hayatabad Medical Complex, Peshawar, Pakistan
Saiqa Zahoor
Associate Professor, Department of Haematology, MTI-Hayatabad Medical Complex, Peshawar, Pakistan
Gul Rukh
PG Trainee, Department of Haematology, MTI-Hayatabad Medical Complex, Peshawar, Pakistan
Hafsa Tariq
PG Trainee, Department of Haematology, Pak International Medical College, Peshawar, Pakistan
Hamid Mahabat Khan
PG Trainee, Department of Haematology, MTI-Hayatabad Medical Complex, Peshawar, Pakistan