Kadir Serkan YALÇIN, Hümeyra YÜCETÜRK, Benan KASAPOĞLU, Murat KEKİLLİ

COVID-19 hastalarında uzamış D-dimer yüksekliği ve herediter trombofili arasındaki ilişki

Amaç: Bu çalışmada herediter trombofili olan ve olmayan hafif Covid-19 hastalarında D-Dimer düzeylerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Tekrarlayan düşük ve venöz emboli gibi çeşitli nedenlerle daha önce Faktör V leiden (G1691A) mutasyonu, metilen tetrahidrofolat gen mutasyonu (C677T, A1298C), PAI-1 (4G-5G) ve FXIII (V34L) gen mutasyonları bakılmış olan hastalar çalışmaya alındı. Herhangi bir mutasyonu olan hastalar kalıtsal trombofili grubuna, mutasyonu olmayan hastalar kontrol grubuna alındı. Hastaların D-dimer düzeyleri başvurudan en az 25 gün sonra bir kez daha kontrol edilmişti. Çalışmaya dahil edilen tüm hastalar daha önce BioNTech-Pfizer veya CoronaVac aşılarından en az iki doz olmuştu. Bulgular: Çalışmaya 46 (%29,1) erkek ve 112 (%70,9) kadın olmak üzere toplam 158 hasta dahil edildi. Hastaların yaş ortalaması 39,08±9,09 idi. Herediter trombofilisi olan 33 (%27,3) erkek, 88 (72,7) kadın toplam 121 hasta birinci grup olarak alındı. Herhangi bir mutasyonu olmayan 13 (%35,1) erkek ve 24 (%64,9) kadın toplam 37 hasta ise kotrol grubu olarak alındı. Kalıtsal trombofili hastalarının 47’sinde (%38,8) Faktör V Leiden, 63’ünde (%52,1) MTHFR gen mutasyonu, 32’sinde (%26,4) PAI-1 ve 12’sinde (%9,9) FXIII gen mutasyonu vardı. Hastaneye yatıştan 20-35 gün sonra her iki grubun D-dimer değerleri incelendiğinde, herediter trombofili grubunun D-dimer düzeyi 667,26 ±354,11, kontrol grubunun D-dimer düzeyi 369,76±3; 173,45 (P=0,031) olarak buluındu. Herediter trombofili grubundaki 23 hastanın ve trombofili olmayan 2 hastanın kontrole geldiklerinde D-dimer düzeyleri 1000ng/ml’nin üzerinde bulundu. Sonuç: Hafif-orta semptomları olan COVID-19 hastalığında uzamış veya yeni ortaya çıkan D-dimer yüksekliği varsa bu hastalarda kalıtsal trombofili olabileceği akılda tutulmalıdır.

Anahtar Kelimeler:

COVID-19, hereiditer trombofili, D-dimer

The relationship between extended D-dimer elevations and hereditary thrombophilia in COVID-19 patients

Aim: To compare the D-Dimer levels in patients with mild COVID-19 disease with and without hereditary thrombophilia. Material and Method: Factor V Leiden (G1691A) mutation, methylene tetrahydrofolate gene mutation (C677T, A1298C), and PAI-1 (4G-5G) and FXIII (V34L) gene mutations were examined in all patients included in the study for various reasons such as recurrent miscarriage and venous embolism. Patients with any mutation were included in the hereditary thrombophilia group, while patients without mutations were included in the control group. D-dimer levels of the patients were also analyzed for the second time at least 25 days after admission. All included patients had received previously at least two doses of the BioNTech-Pfizer or CoronaVac vaccines. Results: A total of 158 patients, 46 (29.1%) male and 112 (70.9%) female, were included in the study. The mean age of the patients included in the study was 39.08 ± 9.09 years. A total of 121 patients, 33 (27.3%) men and 88 (72.7) women, with hereditary thrombophilia were in the first group. A total of 37 patients, 13 (35.1%) male and 24 (64.9%) female, who did not have any mutations, were taken as the control group. Of the patients with hereditary thrombophilia, 47 (38.8%) had Factor V Leiden, 63 (52.1%) had MTHFR gene mutations, 32 (26.4%) had PAI-1 and 12 (9.9%) had FXIII gene mutations. When the D-dimer values of both groups were examined 20-35 days after admission to the hospital, the D-dimer level of the hereditary thrombophilia group was 667.26 ±354.11 while the D-dimer level of the control group was 369.76±173.45 (P=0.031). The D-dimer level of 23 patients in the hereditary thrombophilia group and 2 patients without thrombophilia were found to be above 1000ng/ml when they came for control. Conclusion: It should be kept in mind that if there is prolonged or newly emerging D-dimer elevation in patients who had COVID-19 disease with mild-moderate symptoms, these patients may have hereditary thrombophilia.

Keywords:

COVID-19, Heredidary thrombophilia, D-dimer,

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