Comparison between D-dimer Levels of Covid-19 Patients Using New Oral Anticoagulants or Warfarin Due to Nonvalvular Atrial Fibrillation and D-dimer Levels of Covid-19 Patients with Normal Sinus Rhythm

INTRODUCTION: Coronavirus Disease 2019 (Covid-19) patients with concomitant cardiac diseases have poor prognosis and have high mortality and thromboembolic event rates. The aim of this study is to compare D-dimer levels of Covid-19 patients using new oral anticoagulants (NOAC) or warfarin due to nonvalvular atrial fibrillation (AF) and Covid-19 patients with normal sinus rhythm (NSR). METHODS: It is an observational retrospective case-control study. 103 consecutive patients, 50 (0.11%) AF and 53 (0.12%) NSR with laboratory confirmed Covid-19 PCR positivity and patients who are PCR negative but have a high clinical suspicion of Covid-19 due to their contact history, laboratory and computed tomography findings were enrolled. The eligible patients of similar age and gender were divided into AF and NSR groups. Admission and control D-dimer levels were compared. RESULTS: On admission mean D-dimer levels were 2.07 ± 4.41 µg/ml and 1.89 ± 3.87 µg/ml in the AF and NSR group, respectively: between two groups no statistically significant difference was found (p=0.345). Control D-dimer levels on the fifth day of treatment were 2.18 ± 3.31 µg/ml and 2.06 ± 3.44 µg/ml in the AF and NSR group, respectively: between two groups no statistically significant difference was found (p=0.814). DISCUSSION and CONCLUSION: In patients using NOAC or warfarin due to nonvalvular AF, no increase in thromboembolism event rates and elevated D-dimer levels were observed during the Covid-19 process. There was no study in the literatüre that compared D-dimer levels and thromboembolic event rates of AF and NSR group with Covid-19 patients.

Nonvalvüler Atrial Fibrilasyon Nedeni ile Yeni Oral Antikoagülan veya Varfarin Kullanan Covid-19 Tanılı Hastaların D-dimer Düzeyleri ile Normal Sinüs Ritmindeki Covid-19 Tanılı Hastaların D-dimer Düzeylerinin Karşılaştırılması

GİRİŞ ve AMAÇ: Koronavirüs hastalığı-19 (Covid-19), eşlik eden kalp hastalığı olan hastalarda kötü prognoza sahiptir ve yüksek mortalite ve tromboembolik olay oranlarına sahiptir.Bu çalışmanın amacı; Covid-19 lu nonvalvüler atrial fibrilasyon (AF) nedeni ile yeni oral antikoagülan veya varfarin kullanan hastaların D-dimer düzeyleri ile Covid-19'lu normal sinüs ritmindeki (NSR) hastaların D-dimer düzeylerinin karşılaştırılmasıdır. YÖNTEM ve GEREÇLER: Bu çalışma retrospektif gözlemsel vaka-kontrol çalışmasıdır. Laboratuvar onaylı PCR pozitif Covid19'lu hastalar ve PCR negatif fakat temas öyküsü, laboratuvar ve bilgisayarlı tomografi bulguları olan yüksek klinik şüphesi olan Covid-19'lu 50 (%0.11) si AF li ve 53 (%0.12) ü NSR olan toplam 103 ardışık hasta çalışmaya alındı. Benzer yaş ve cinsiyetteki uygun hastalar AF ve NSR grubu olarak ikiye bölündü. Hastaneye başvurudaki ve kontroldeki D-dimer düzeyleri karşılaştırıldı. BULGULAR: Hastaneye kabulde, AF ve NSR grubundaki ortalama D-dimer seviyeleri sırasıyla 2.07 ± 4.41 µg/ml ve 1.89 ± 3.87 µg/ml idi: iki grup arasında istatistiksel olarak fark yoktu (p=0.345). Tedavinin beşinci gününde AF ve NSR grubundaki ortalama kontrol D-dimer seviyeleri sırasıyla 2.18 ± 3.31 µg/ml ve 2.06 ± 3.44 µg/ml idi: iki grup arasında istatistiksel olarak fark yoktu (p=0.814). İki grup arasında mortalite analizi yapıldığında hastaneye kabulde yaşayan Covid-19'lu hastaların ortalama Ddimer seviyeleri 1.40± 3.30 µg/ml iken yaşamayan Covid-19'lu hastaların D-dimer seviyeleri 4.41± 6.30 µg/ml idi: iki grup arasında belirgin fark vardı ve bu fark istatistiksel olarak anlamlı idi p= 0.020. TARTIŞMA ve SONUÇ: Nonvalvüler AF nedeniyle NOAC veya varfarin kullanan hastalarda Covid-19 sürecinde tromboembolizm oranlarında ve D-dimer düzeylerinde artış izlenmedi. Literatürde, Covid-19 hastalarında AF'li ve NSR'de olanlar karşılaştırıldığında D-dimer düzeylerini ve tromboembolik oranlarını karşılaştıran çalışmaya rastlanmadı.

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