Impact of High-Dose Prophylactic Anticoagulation in Critically Ill Patients With COVID-19 Pneumonia.
COVID-19
anticoagulation
bleeding
thrombosis
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
22
09
2020
revised:
23
12
2020
accepted:
09
01
2021
pubmed:
20
1
2021
medline:
22
6
2021
entrez:
19
1
2021
Statut:
ppublish
Résumé
Because of the high risk of thrombotic complications (TCs) during SARS-CoV-2 infection, several scientific societies have proposed to increase the dose of preventive anticoagulation, although arguments in favor of this strategy are inconsistent. What is the incidence of TC in critically ill patients with COVID-19 and what is the relationship between the dose of anticoagulant therapy and the incidence of TC? All consecutive patients referred to eight French ICUs for COVID-19 were included in this observational study. Clinical and laboratory data were collected from ICU admission to day 14, including anticoagulation status and thrombotic and hemorrhagic events. The effect of high-dose prophylactic anticoagulation (either at intermediate or equivalent to therapeutic dose), defined using a standardized protocol of classification, was assessed using a time-varying exposure model using inverse probability of treatment weight. Of 538 patients included, 104 patients experienced a total of 122 TCs with an incidence of 22.7% (95% CI, 19.2%-26.3%). Pulmonary embolism accounted for 52% of the recorded TCs. High-dose prophylactic anticoagulation was associated with a significant reduced risk of TC (hazard ratio, 0.81; 95% CI, 0.66-0.99) without increasing the risk of bleeding (HR, 1.11; 95% CI, 0.70-1.75). High-dose prophylactic anticoagulation is associated with a reduction in thrombotic complications in critically ill patients with COVID-19 without an increased risk of hemorrhage. Randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results. ClinicalTrials.gov; No.: NCT04405869; URL: www.clinicaltrials.gov.
Sections du résumé
BACKGROUND
Because of the high risk of thrombotic complications (TCs) during SARS-CoV-2 infection, several scientific societies have proposed to increase the dose of preventive anticoagulation, although arguments in favor of this strategy are inconsistent.
RESEARCH QUESTION
What is the incidence of TC in critically ill patients with COVID-19 and what is the relationship between the dose of anticoagulant therapy and the incidence of TC?
STUDY DESIGN AND METHODS
All consecutive patients referred to eight French ICUs for COVID-19 were included in this observational study. Clinical and laboratory data were collected from ICU admission to day 14, including anticoagulation status and thrombotic and hemorrhagic events. The effect of high-dose prophylactic anticoagulation (either at intermediate or equivalent to therapeutic dose), defined using a standardized protocol of classification, was assessed using a time-varying exposure model using inverse probability of treatment weight.
RESULTS
Of 538 patients included, 104 patients experienced a total of 122 TCs with an incidence of 22.7% (95% CI, 19.2%-26.3%). Pulmonary embolism accounted for 52% of the recorded TCs. High-dose prophylactic anticoagulation was associated with a significant reduced risk of TC (hazard ratio, 0.81; 95% CI, 0.66-0.99) without increasing the risk of bleeding (HR, 1.11; 95% CI, 0.70-1.75).
INTERPRETATION
High-dose prophylactic anticoagulation is associated with a reduction in thrombotic complications in critically ill patients with COVID-19 without an increased risk of hemorrhage. Randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results.
TRIAL REGISTRY
ClinicalTrials.gov; No.: NCT04405869; URL: www.clinicaltrials.gov.
Identifiants
pubmed: 33465342
pii: S0012-3692(21)00047-7
doi: 10.1016/j.chest.2021.01.017
pmc: PMC7832130
pii:
doi:
Substances chimiques
Anticoagulants
0
Banques de données
ClinicalTrials.gov
['NCT04405869']
Types de publication
Letter
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2417-2427Investigateurs
P Albaladejo
(P)
N Blais
(N)
F Bonhomme
(F)
A Borel-Derlon
(A)
A Cohen
(A)
J-P Collet
(JP)
E de Maistre
(E)
P Fontana
(P)
D Garrigue Huet
(D)
A Godier
(A)
Y Gruel
(Y)
A Godon
(A)
B Ickx
(B)
S Laporte
(S)
D Lasne
(D)
J Llau
(J)
G Le Gal
(G)
T Lecompte
(T)
S Lessire
(S)
J H Levy
(JH)
D Longrois
(D)
S Madi-Jebara
(S)
A Mansour
(A)
M Mazighi
(M)
P Mismetti
(P)
P E Morange
(PE)
S Motte
(S)
F Mullier
(F)
N Nathan
(N)
P Nguyen
(P)
G Pernod
(G)
N Rosencher
(N)
S Roullet
(S)
P M Roy
(PM)
S Schlumberger
(S)
P Sié
(P)
A Steib
(A)
S Susen
(S)
C A Tacquard
(CA)
S Testa
(S)
A Vincentelli
(A)
P Zufferey
(P)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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