TY - JOUR
T1 - Impact of augmented renal clearance on anticoagulant therapy in critically ill patients with coronavirus disease 2019
T2 - A retrospective cohort study
AU - Kamidani, Ryo
AU - Okada, Hideshi
AU - Kawasaki, Yuki
AU - Shimada, Takuto
AU - Tamaoki, Yuto
AU - Nakashima, Yusuke
AU - Nishio, Ayane
AU - Fukuda, Hirotsugu
AU - Minamiyama, Toru
AU - Yoshida, Tomoki
AU - Yoshimura, Genki
AU - Miura, Tomotaka
AU - Ishihara, Takuma
AU - Fukuta, Tetsuya
AU - Kitagawa, Yuichiro
AU - Suzuki, Kodai
AU - Miyake, Takahito
AU - Doi, Tomoaki
AU - Yoshida, Takahiro
AU - Tetsuka, Nobuyuki
AU - Yoshida, Shozo
AU - Ogura, Shinji
N1 - Publisher Copyright:
© 2023 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control
PY - 2024/2
Y1 - 2024/2
N2 - Introduction: This study aimed to determine the impact of augmented renal clearance (ARC) on anticoagulation therapy in critically ill patients with coronavirus disease 2019 (COVID-19). Methods: This retrospective cohort study included adult patients with severe COVID-19 with ARC who had been treated at our hospital between 2020 and 2021. We measured the estimated glomerular filtration rate calculated by the Chronic Kidney Disease Epidemiology Collaboration formula (eGFRCKD-EPI) every morning, and ARC condition was defined as eGFRCKD-EPI ≥ 130 mL/min/1.73 m2. Multivariate regression analysis with Huber–White sandwich estimator was performed to examine the association of unfractionated heparin (UH) dosage between blood test timings with activated partial thromboplastin time (APTT) compared with and without ARC. Results: We identified 38 enrolled patients: seven and 31 in the ARC and non-ARC groups, respectively. In the ARC coexisting condition, a higher dose of UH, which corresponded to the total dose in 24 h from the previous day, was required to achieve the same APTT prolongation, with a significant difference (p < 0.001). Conclusions: Our study suggests that careful monitoring and consideration of higher UH doses in critically ill patients with COVID-19 is necessary because anticoagulation failure can occur during ARC.
AB - Introduction: This study aimed to determine the impact of augmented renal clearance (ARC) on anticoagulation therapy in critically ill patients with coronavirus disease 2019 (COVID-19). Methods: This retrospective cohort study included adult patients with severe COVID-19 with ARC who had been treated at our hospital between 2020 and 2021. We measured the estimated glomerular filtration rate calculated by the Chronic Kidney Disease Epidemiology Collaboration formula (eGFRCKD-EPI) every morning, and ARC condition was defined as eGFRCKD-EPI ≥ 130 mL/min/1.73 m2. Multivariate regression analysis with Huber–White sandwich estimator was performed to examine the association of unfractionated heparin (UH) dosage between blood test timings with activated partial thromboplastin time (APTT) compared with and without ARC. Results: We identified 38 enrolled patients: seven and 31 in the ARC and non-ARC groups, respectively. In the ARC coexisting condition, a higher dose of UH, which corresponded to the total dose in 24 h from the previous day, was required to achieve the same APTT prolongation, with a significant difference (p < 0.001). Conclusions: Our study suggests that careful monitoring and consideration of higher UH doses in critically ill patients with COVID-19 is necessary because anticoagulation failure can occur during ARC.
KW - Anticoagulant therapy
KW - Augmented renal clearance
KW - COVID-19
KW - Cohort study
KW - Unfractionated heparin
UR - http://www.scopus.com/inward/record.url?scp=85171659924&partnerID=8YFLogxK
U2 - 10.1016/j.jiac.2023.09.017
DO - 10.1016/j.jiac.2023.09.017
M3 - 学術論文
C2 - 37717607
AN - SCOPUS:85171659924
SN - 1341-321X
VL - 30
SP - 111
EP - 117
JO - Journal of Infection and Chemotherapy
JF - Journal of Infection and Chemotherapy
IS - 2
ER -
