PMID- 32445064
OWN - NLM
STAT- MEDLINE
DCOM- 20200722
LR  - 20220716
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 50
IP  - 2
DP  - 2020 Aug
TI  - Heparin resistance in COVID-19 patients in the intensive care unit.
PG  - 287-291
LID - 10.1007/s11239-020-02145-0 [doi]
AB  - Patients with COVID-19 have a coagulopathy and high thrombotic risk. In a cohort 
      of 69 intensive care unit (ICU) patients we investigated for evidence of heparin 
      resistance in those that have received therapeutic anticoagulation. 15 of the 
      patients have received therapeutic anticoagulation with either unfractionated 
      heparin (UFH) or low molecular weight heparin (LMWH), of which full information 
      was available on 14 patients. Heparin resistance to UFH was documented in 8/10 
      (80%) patients and sub-optimal peak anti-Xa following therapeutic LMWH in 5/5 
      (100%) patients where this was measured (some patients received both 
      anticoagulants sequentially). Spiking plasma from 12 COVID-19 ICU patient samples 
      demonstrated decreased in-vitro recovery of anti-Xa compared to normal pooled 
      plasma. In conclusion, we have found evidence of heparin resistance in critically 
      unwell COVID-19 patients. Further studies investigating this are required to 
      determine the optimal thromboprophylaxis in COVID-19 and management of thrombotic 
      episodes.
FAU - White, D
AU  - White D
AD  - Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK.
FAU - MacDonald, S
AU  - MacDonald S
AD  - Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK.
FAU - Bull, T
AU  - Bull T
AD  - Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK.
FAU - Hayman, M
AU  - Hayman M
AD  - Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK.
FAU - de Monteverde-Robb, R
AU  - de Monteverde-Robb R
AD  - Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK.
FAU - Sapsford, D
AU  - Sapsford D
AD  - Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK.
FAU - Lavinio, A
AU  - Lavinio A
AD  - Department of Intensive Care Medicine, Cambridge University Hospitals NHS 
      Foundation Trust, Cambridge, UK.
FAU - Varley, J
AU  - Varley J
AD  - Department of Intensive Care Medicine, Cambridge University Hospitals NHS 
      Foundation Trust, Cambridge, UK.
FAU - Johnston, A
AU  - Johnston A
AD  - Department of Intensive Care Medicine, Cambridge University Hospitals NHS 
      Foundation Trust, Cambridge, UK.
FAU - Besser, M
AU  - Besser M
AD  - Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK.
FAU - Thomas, W
AU  - Thomas W
AUID- ORCID: 0000-0001-6969-3173
AD  - Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, 
      Cambridge, UK. william.thomas@addenbrookes.nhs.uk.
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
EIN - J Thromb Thrombolysis. 2020 Jun 22;:. PMID: 32572676
CIN - J Thromb Thrombolysis. 2020 Nov;50(4):1015-1016. PMID: 32880796
MH  - Adult
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Betacoronavirus/*pathogenicity
MH  - Blood Coagulation/*drug effects
MH  - Blood Coagulation Tests
MH  - COVID-19
MH  - Coronavirus Infections/blood/diagnosis/*therapy/virology
MH  - Drug Monitoring
MH  - *Drug Resistance
MH  - Female
MH  - Heparin/adverse effects/*therapeutic use
MH  - Host-Pathogen Interactions
MH  - Humans
MH  - *Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Pandemics
MH  - Pneumonia, Viral/blood/diagnosis/*therapy/virology
MH  - Retrospective Studies
MH  - SARS-CoV-2
MH  - Thrombosis/blood/diagnosis/*drug therapy/virology
MH  - Treatment Outcome
PMC - PMC7242778
OTO - NOTNLM
OT  - COVID-19
OT  - Heparin
OT  - Intensive care
OT  - Thrombosis
COIS- MB-speakers fee STAGO, Advisory board Novartis, Cosmopharma, Werfen. WT-speakers 
      fees from Pfizer, Bayer, Takeda and advisory boards for Daiichi-Sankyo, Sanofi 
      and Ablynx. No other authors declared relevant conflicts of interest.
EDAT- 2020/05/24 06:00
MHDA- 2020/07/23 06:00
PMCR- 2020/05/22
CRDT- 2020/05/24 06:00
PHST- 2020/05/24 06:00 [pubmed]
PHST- 2020/07/23 06:00 [medline]
PHST- 2020/05/24 06:00 [entrez]
PHST- 2020/05/22 00:00 [pmc-release]
AID - 10.1007/s11239-020-02145-0 [pii]
AID - 2145 [pii]
AID - 10.1007/s11239-020-02145-0 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2020 Aug;50(2):287-291. doi: 10.1007/s11239-020-02145-0.