Critical coronavirus disease 2019 complicated with heparin resistance in 2 patients
10.3760/cma.j.cn121430-20220106-00012
- VernacularTitle:危重型新型冠状病毒肺炎患者合并肝素抵抗2例
- Author:
Yongpeng XIE
1
;
Jiye LUO
;
Jiguang LI
;
Ting GE
;
Yao YAN
;
Weijian CAO
;
Xiaomin LI
Author Information
1. 连云港市第一人民医院急危重症医学部，连云港市急诊医学研究所，江苏连云港 222000
- Keywords:
Coronavirus disease 2019, severe;
Acute respiratory distress syndrome;
Heparin resistance;
Deep vein thrombosis;
Extracorporeal membrane oxygenation
- From:
Chinese Critical Care Medicine
2022;34(5):509-513
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the diagnosis process and treatment experience of severe coronavirus disease 2019 (COVID-19) patients with heparin resistance (HR).Methods:The medical team of the First People's Hospital of Lianyungang admitted 2 severe COVID-19 patients with HR in intensive care unit (ICU) during their support to the designated hospital for the treatment of COVID-19 patients in Lianyungang City in November 2021. The clinical features, laboratory examinations, imaging features, treatment and prognosis of the two patients were analyzed.Results:Both severe COVID-19 patients received mechanical ventilation, 1 patient was treated with extracorporeal membrane oxygenation (ECMO) support. Both patients were complicated with lower extremity deep venous thrombosis and HR phenomenon under routine dose anticoagulant therapy. The maximum daily dose of unfractionated heparin exceeded 35 000 U (up to 43 200 U), the 2 patients failed to meet the standard of anticoagulation treatment, and the course of disease was prolonged. After that, argatroban was given 0.4 μg·kg -1·min -1 combined with anticoagulant therapy, the activated partial thromboplastin time (APTT) of patients undergoing ECMO could be maintained at 55-60 seconds and the activated coagulation time (ACT) of them could be maintained at 180-200 seconds. After ECMO support or later sequential mechanical ventilation, both patients recovered and were discharged, and deep venous thrombosis was also effectively controlled. Conclusion:HR phenomenon often occurs during the treatment of severe COVID-19 patients, the anticoagulation regimen should be adjusted in time, and the anticoagulation effect combined with argatroban is clear.
