The hazard of (sub)therapeutic doses of anticoagulants in non-critically ill patients with Covid-19: The Padua province experience.
Aged
Aged, 80 and over
Anticoagulants
/ administration & dosage
Blood Coagulation
/ drug effects
COVID-19
/ blood
Clinical Decision-Making
Female
Hemorrhage
/ chemically induced
Humans
Incidence
Italy
/ epidemiology
Male
Middle Aged
Patient Safety
Retrospective Studies
Risk Assessment
Risk Factors
Thrombosis
/ blood
Treatment Outcome
Venous Thromboembolism
/ blood
COVID-19 Drug Treatment
COVID-19
anticoagulants
bleeding
coronavirus 2019
venous thromboembolism
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
03
06
2020
revised:
06
07
2020
accepted:
15
07
2020
pubmed:
22
7
2020
medline:
29
12
2020
entrez:
22
7
2020
Statut:
ppublish
Résumé
Coronavirus Disease 2019 (COVID-19) is responsible for a worldwide pandemic, with a high rate of morbidity and mortality. The increasing evidence of an associated relevant prothrombotic coagulopathy has resulted in an increasing use of antithrombotic doses higher than usual in COVID-19 patients. Information on the benefit/risk ratio of this approach is still lacking. To assess the incidence of relevant bleeding complications in association with the antithrombotic strategy and its relationship with the amount of drug. Consecutive COVID-19 patients admitted between February and April 2020 were included in a retrospective analysis. Major bleedings (MB) and clinically relevant non-major bleeding (CRNMB) were obtained from patient medical records and were adjudicated by an independent committee. Of the 324 patients who were recruited, 240 had been treated with prophylactic doses and 84 with higher doses of anticoagulants. The rate of the composite endpoint of MB or CRNMB was 6.9 per 100-person/months in patients who had been given prophylactic doses, and 26.4 per 100-person/months in those who had been prescribed higher doses (hazard ratio, 3.89; 95% confidence interval, 1.90-7.97). The corresponding rates for overall mortality were 12.2 and 20.1 per 100-person/months, respectively. The rate of relevant bleeding events was high in patients treated with (sub)therapeutic doses of anticoagulants. In the latter group, overall mortality did not differ from that of patients treated with standard prophylactic doses and was even higher. Our result does not support a strategy of giving (sub)therapeutic doses of anticoagulants in non-critically ill patients with COVID-19.
Sections du résumé
BACKGROUND
BACKGROUND
Coronavirus Disease 2019 (COVID-19) is responsible for a worldwide pandemic, with a high rate of morbidity and mortality. The increasing evidence of an associated relevant prothrombotic coagulopathy has resulted in an increasing use of antithrombotic doses higher than usual in COVID-19 patients. Information on the benefit/risk ratio of this approach is still lacking.
OBJECTIVE
OBJECTIVE
To assess the incidence of relevant bleeding complications in association with the antithrombotic strategy and its relationship with the amount of drug.
METHODS
METHODS
Consecutive COVID-19 patients admitted between February and April 2020 were included in a retrospective analysis. Major bleedings (MB) and clinically relevant non-major bleeding (CRNMB) were obtained from patient medical records and were adjudicated by an independent committee.
RESULTS
RESULTS
Of the 324 patients who were recruited, 240 had been treated with prophylactic doses and 84 with higher doses of anticoagulants. The rate of the composite endpoint of MB or CRNMB was 6.9 per 100-person/months in patients who had been given prophylactic doses, and 26.4 per 100-person/months in those who had been prescribed higher doses (hazard ratio, 3.89; 95% confidence interval, 1.90-7.97). The corresponding rates for overall mortality were 12.2 and 20.1 per 100-person/months, respectively.
CONCLUSIONS
CONCLUSIONS
The rate of relevant bleeding events was high in patients treated with (sub)therapeutic doses of anticoagulants. In the latter group, overall mortality did not differ from that of patients treated with standard prophylactic doses and was even higher. Our result does not support a strategy of giving (sub)therapeutic doses of anticoagulants in non-critically ill patients with COVID-19.
Identifiants
pubmed: 32692874
doi: 10.1111/jth.15022
pmc: PMC7404507
pii: S1538-7836(22)01184-9
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2629-2635Informations de copyright
© 2020 International Society on Thrombosis and Haemostasis.
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