Eosinophil and Anticoagulation in COVID-19 Patients

Abstract

Introduction: Despite prophylactic anticoagulant treatments, thrombotic complications may develop in patients with Coronavirus disease 2019 (COVID-19). This study aimed to evaluate anti-Factor Xa levels to determine the anticoagulant activity of low molecular weight heparin (LMWH) in COVID-19 patients.Materials and methods: We prospectively evaluated 80 COVID-19 patients, diagnosed using polymerase-chain-reaction test, who were admitted to our clinic and administered LMWH; enoxaparin was applied according to the weight, D-dimer levels, and clinical condition of patients. Anti-Factor Xa levels in blood, drawn 4h after the 3rd dose of LMWH, were measured and a level of <0.2IU/ml was considered subprophylactic. Patients were followed up clinically and anti-Factor Xa levels were re-examined before discharge.Results: Groups 1 and 2 included 13 and 67 patients with subprophylactic (0.18±0.06) and prophylactic (0.43±0.23) anti-Factor Xa levels, respectively. The proportion of eosinophils in patients was significantly higher in group 1 than in group 2 (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 (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 <1µg/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).Conclusions: In COVID-19 patients, eosinophil levels could be considered for determining effective prophylactic anticoagulant administration. (NCT04507282)