Prognostic Value of Antithrombin Levels in COVID-19 Patients and Impact of Fresh Frozen Plasma Treatment: A Retrospective Study

Abstract

Objective: The defective interplay between coagulation and inflammation may be the leading cause of intravascular coagulation and organ dysfunction in coronavirus disease-19 (COVID-19) patients. Abnormal coagulation profiles were reported to be associated with poor outcomes. In this study, we assessed the prognostic values of antithrombin (AT) activity levels and the impact of fresh frozen plasma (FFP) treatment on outcome. Materials and Methods: Conventional coagulation parameters as well as AT activity levels and outcomes of 104 consecutive critically ill acute respiratory distress syndrome (ARDS) patients with laboratory-confirmed COVID-19 disease were retrospectively analyzed. Patients with AT activity below 75% were treated with FFP. Maximum AT activity levels achieved in those patients were recorded. Results: AT activity levels at admission were significantly lower in nonsurvivors than survivors (73% vs. 81%). The cutoff level for admission AT activity was 79% and 58% was the lowest AT for survival. The outcome in those patients who had AT activity levels above 75% after FFP treatment was better than that of the nonresponding group. As well as AT, admission values of D-dimer, C-reactive protein, and procalcitonin were coagulation and inflammatory parameters among the mortality risk factors. Conclusion: AT activity could be used as a prognostic marker for survival and organ failure in COVID-19-associated ARDS patients. AT supplementation therapy with FFP in patients with COVID-19-induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival.

The Impact of SARS-CoV-2 Infection on Blood Coagulation and Fibrinolytic Pathways: A Review of Prothrombotic Changes Caused by COVID-19

“…112 Antithrombin supplementation has also been a valuable measure for management of critically ill patients. 108,113 However, it is yet unknown why the acute antithrombin deficiency occurs in only some patients. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH), the two anticoagulants that are widely used in hospitals, require antithrombin to be efficacious.…”

Antithrombin, COVID-19, and Fresh Frozen Plasma Treatment

“…We found the article entitled “Prognostic value of antithrombin levels in COVID-19 patients and impact of fresh frozen plasma treatment: a retrospective study” very interesting [ 1 ]. Considering antithrombin (AT) levels and fresh frozen plasma (FFP) in these patients, Anaklı et al [ 1 ] concluded that “AT activity could be used as a prognostic marker for survival and organ failure in COVID-19-associated ARDS patients. AT supplementation therapy with FFP in patients with COVID-19-induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival” [ 1 ].…”

“…Considering antithrombin (AT) levels and fresh frozen plasma (FFP) in these patients, Anaklı et al [ 1 ] concluded that “AT activity could be used as a prognostic marker for survival and organ failure in COVID-19-associated ARDS patients. AT supplementation therapy with FFP in patients with COVID-19-induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival” [ 1 ]. Indeed, plasma therapy is a widely discussed alternative option for management of severe coronavirus disease-19 (COVID-19).…”

Adequate Antithrombin III Level Predicts Survival in Severe COVID-19 Pneumonia

“…ATIII deficiency has been observed in COVID-19 patients in previous studies [7,9,10,14,15]. Gazzaruso et al observed that ATIII levels were lower in non-survivors amongst hospitalized COVID-19 patients and the levels were much lower in obese individuals.…”