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.