Effect of Fluid Therapy on Coagulation in COVID-19 Patients in the Intensive Care Unit
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Keywords
COVID 19, coagulation, fluid therapy, intensive care unit
Abstract
Study Objectives: Coagulopathy is known to be common in COVID-19 patients. Several studies have evaluated CT pulmonary angiography of COVID-19 patients who did or did not receive anticoagulant therapy and reported a 7%–30% increase in the incidence of pulmonary embolism. In this study, it was aimed to investigate the effect of fluid therapy on coagulation in COVID 19 patients in the intensive care unit. Methods: This retrospective study was approved by the Ethics Committee of Erzincan Binali Yıldırım University. The study included 120 patients hospitalized in COVID 19 Intensive Care Unit of Anesthesiology and Reanimation Department for more than one week, between August 2020 and February 2021. Blood prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen, troponin, D-dimer levels and platelet count measured at the time of admission (T1, baseline) and one week after admission (T2), and the fluid treatments administered during this period were recorded. Patients were divided into the saline solution (SS) group (n=75), 0.45% saline solution group (0.45% group, n=30), and combined fluid therapy group (SS+0.45% group, n=15). Also, all patients received enoxaparin sodium for anticoagulation. Patients with sepsis, or septic shock were excluded.
Results: The change in PT was statistically significant for the SS group (P =0.005), but not for the 0.45% and SS+0.45% groups (P =0.625, P =0.262, respectively). In the SS group, the aPTT levels increased posttreatment (P =0.005). There were no significant changes in the 0.45% and SS+0.45% groups. INR levels were significantly different between SS and SS+0.45% groups (P =0.008). In the SS group, the INR levels increased between T1 and T2 (P =0.014). In the SS group, the D-dimer levels significantly increased posttreatment. The remaining parameters did not significantly change among groups. Conclusion: In conclusion, due to hypercoagulation and the associated complications, the D-dimer levels were prominent in the follow-up of the COVID-19 patients. Accordingly, using SS for fluid therapy may increase hypercoagulation and the risk of an embolism when compared to the SS, 0.45%, and combined (SS+0.45%) treatment.
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