DECLARATIONS
Funding: No specific funding was received from any bodies in
the public, commercial or not-for-profit sectors to carry out work
described in this article.
Conflicts of Interest: The authors declare no conflicts of
interest.
Availability of data and material: The Dataset of the study is
available from the corresponding author on reasonable request.
Code availability: Not applicable.
Author contributions: MB and RÇ designed and planned the study,
RÇ, SY, MA, MHU, and MİK collected the data, SY and MB carried out the
data evaluation and basic analyses, all authors contributed to the
follow-up of the patients and interpretation of results. RÇ and MB wrote
the first draft, and all authors provided critical feedback for the last
version.
Ethics approval : Individual written patient consent and local
ethic committee approval was obtained for this study (date/number:
24.02.2022, 2022/04-09).
Word count: 3326 words in main text without references
Abstract word count : 248 words.
Number of tables : 5 tables, 1 supplementary table
Number of figures: 3 figures and 17 supplementary figures
References: 45
Supplementary data: Yes
Introduction: 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.
Material and methods : This retrospective observational study
was conducted at a tertiary referral center in Aksaray, Turkey. The
study population consisted of two groups as follows; the patients
receiving high dose intravenous anakinra (anakinra group) added to
background therapy and the patients treated with standard of care (SoC)
as historical control group. Age, gender, mcHIS scores, and
comorbidities such as DM, HT, and CHD of the patients were determined as
the variables to be matched.
Results: We included 114 patients in SoC and 139 patients in
Anakinra group into the study. Development of any thromboembolic event
(5% vs 12.3%, p=0.038; OR:4.3) and PTE (2.9% vs 9.6%, p=0.023;
OR:5.1) were lower in Anakinra group than SoC. No patient experienced
CVA and/or clinically evident DVT both in two arms.
After 1:1 PS matching, 88 patients in SoC and 88 patients in Anakinra
group were matched and included into the analysis. In survival analysis,
development of any thromboembolic event, PTE, and MI were higher in SoC
compared to Anakinra. Survival rate was also lower in patients with SoC
arm than Anakinra in patients who had any thromboembolic event as well
as MI.
Conclusion : In our study, development of thrombosis were
associated with hyperinflammation in patients with severe and critical
COVID-19. Intravenous high-dose anakinra treatment decreases both venous
and arterial events in patients with COVID-19.
Key words: Anakinra, COVID-19, thrombosis, inflammasome,
hyperinflammation