PMID- 36282222
OWN - NLM
STAT- MEDLINE
DCOM- 20230302
LR  - 20230302
IS  - 1827-1596 (Electronic)
IS  - 0375-9393 (Linking)
VI  - 89
IP  - 1-2
DP  - 2023 Jan-Feb
TI  - Impact of corticosteroids on the procoagulant profile of critically ill COVID-19 
      patients: a before-after study.
PG  - 48-55
LID - 10.23736/S0375-9393.22.16640-X [doi]
AB  - BACKGROUND: Several studies have reported an increased risk of thrombotic events 
      in COVID-19 patients, but the pathophysiology of this procoagulant phenotype 
      remains poorly understood. We hypothesized that corticosteroids may attenuate 
      this procoagulant state through their anti-inflammatory effects. The aim of this 
      study was to evaluate the impact of dexamethasone (DXM) on the coagulation 
      profile of severely ill COVID-19 patients. METHODS: We conducted a retrospective, 
      observational before/after bi-centric cohort study among ICU patients 
      hospitalized for severe COVID-19 and receiving therapeutic anticoagulation by 
      unfractionated heparin (UFH). Before and after the standardized use of DXM, we 
      compared inflammatory and coagulation profiles, as well as the kinetics of 
      heparin requirement, adjusted for weight and anti-Xa activity. RESULTS: 
      Eighty-six patients were included, 35 in the no-DXM group, and 51 in the DXM 
      group. At admission, CRP and fibrinogen levels were not different between groups, 
      neither were UFH infusion rates. At day 3 after ICU admission, CRP (178+/-94 mg/L 
      vs. 99+/-68 mg/L, P<0.001) and fibrinogen (7.2+/-1.4 g/L vs. 6.1+/-1.4 g/L, P=0.001) 
      significantly decreased in the DXM group, but not in the no-DXM group. Over time, 
      UFH infusion rates were lower in the DXM group (P<0.001) without any significant 
      difference in plasma anti-Xa activity. CRP variations correlated with heparin 
      dose variations between Day 0 and Day 3 (r=0.39, P=0.009). Finally, the incidence 
      of venous thromboembolic events during in-ICU stay was significantly reduced in 
      the DXM group (4 vs. 43%, P<0.0001). CONCLUSIONS: In critically ill COVID-19 
      patients, dexamethasone use was associated with a decrease in both 
      pro-inflammatory and procoagulant profile.
FAU - Gabarre, Paul
AU  - Gabarre P
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
AD  - Sorbonne University, Paris, France.
FAU - Urbina, Tomas
AU  - Urbina T
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
AD  - Sorbonne University, Paris, France.
FAU - Cunat, Sibylle
AU  - Cunat S
AD  - Unit of Intensive Medicine and Resuscitation, Civil Hospital of Strasbourg, 
      Strasbourg, France.
FAU - Merdji, Hamid
AU  - Merdji H
AD  - Unit of Intensive Medicine and Resuscitation, Civil Hospital of Strasbourg, 
      Strasbourg, France.
AD  - INSERM (French National Institute of Health and Medical Research), UMR 1260, 
      Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
FAU - Bonny, Vincent
AU  - Bonny V
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
FAU - Lavillegrand, Jean-Remi
AU  - Lavillegrand JR
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
FAU - Raia, Lisa
AU  - Raia L
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
FAU - Bige, Naike
AU  - Bige N
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
FAU - Baudel, Jean-Luc
AU  - Baudel JL
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
FAU - Maury, Eric
AU  - Maury E
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
AD  - Sorbonne University, Paris, France.
FAU - Guidet, Bertrand
AU  - Guidet B
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France.
AD  - Sorbonne University, Paris, France.
FAU - Helms, Julie
AU  - Helms J
AD  - Unit of Intensive Medicine and Resuscitation, Civil Hospital of Strasbourg, 
      Strasbourg, France.
AD  - INSERM (French National Institute of Health and Medical Research), UMR 1260, 
      Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
FAU - Ait-Oufella, Hafid
AU  - Ait-Oufella H
AD  - Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, 
      France - hafid.aitoufella@aphp.fr.
AD  - Sorbonne University, Paris, France.
AD  - Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, 
      France.
LA  - eng
PT  - Journal Article
DEP - 20221025
PL  - Italy
TA  - Minerva Anestesiol
JT  - Minerva anestesiologica
JID - 0375272
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Anticoagulants)
RN  - 7S5I7G3JQL (Dexamethasone)
RN  - 9001-32-5 (Fibrinogen)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Humans
MH  - *Adrenal Cortex Hormones/therapeutic use
MH  - Anticoagulants/therapeutic use
MH  - Cohort Studies
MH  - Controlled Before-After Studies
MH  - *COVID-19
MH  - Critical Illness
MH  - Dexamethasone/therapeutic use
MH  - Fibrinogen
MH  - *Heparin/therapeutic use
MH  - Retrospective Studies
EDAT- 2022/10/26 06:00
MHDA- 2023/02/09 06:00
CRDT- 2022/10/25 10:35
PHST- 2022/10/26 06:00 [pubmed]
PHST- 2023/02/09 06:00 [medline]
PHST- 2022/10/25 10:35 [entrez]
AID - S0375-9393.22.16640-X [pii]
AID - 10.23736/S0375-9393.22.16640-X [doi]
PST - ppublish
SO  - Minerva Anestesiol. 2023 Jan-Feb;89(1-2):48-55. doi: 
      10.23736/S0375-9393.22.16640-X. Epub 2022 Oct 25.