Introduction
Coronavirus-19 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and affects many organs mainly upper and lower respiratory tracts. Disease severity of COVID-19 is ranged from asymptomatic and/or mild symptoms to potential life-threatining disease including acute respiratory distress syndrome (ARDS), multi-organ failure and even death. Several risk factors such as male gender, advanced age, some comorbidities including diabetes mellitus (DM), hypertension (HT) and coronary heart disease (CHD), and immunosuppressive treatment were described for the development of poor prognosis as well as severe course in COVID-19 (Verity et al., 2020).
Hyperinflammation (cytokine storm) is one of the main features of severe disease in COVID-19 and also closely associated with poor outcome including ARDS, need of oxygen therapy and higher mortality (Tufan, Avanoğlu Güler, & Matucci-Cerinic, 2020). Several immunomodulatory treatments such as corticosteroids, baricitinib, anakinra, and tocilizumab were found to be effective in COVID-19 patients with signs of hyperinflammation (Kyriazopoulou et al., 2021) (Marconi et al., 2021) (Horby et al., 2021) (”Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial,” 2021).
In addition to cytokine storm, some patients suffer from thrombotic events including myocardial infarction (MI), cerebrovascular accident (CVA), and venous thromboembolism (VTE) such as deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) during the course of COVID-19 (Asakura & Ogawa, 2021). Thereby, prophylactic use of anticoagulant and/or antiaggregant therapies were applied especially in hospitalized COVID-19 patients in daily practise (Middeldorp et al., 2020). Although some studies has shown reduced mortality with profilactic use of anticoagulant therapy reduces mortality (Tang et al., 2020) (Albani et al., 2020) and also development of thromboembolic events (Lachant et al., 2020), there are conflicting results with benefit of anticoagulant therapy in terms of mortality and/or thrombosis (Sadeghipour et al., 2021). Moreover, it is not known whether immunomodulatory therapy reduces thromboembolic events in patients with severe COVID-19.
In our study, we aimed to evaluate the effect of high dose intravenous anakinra treatment on development of thrombotic events in severe and critical COVID-19 patients.