Announcement

Collapse
No announcement yet.

Front Cardiovasc Med . A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Front Cardiovasc Med . A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data


    Front Cardiovasc Med


    . 2022 Aug 16;9:978420.
    doi: 10.3389/fcvm.2022.978420. eCollection 2022.
    A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data


    Ahmed Alrashed 1 , Peter Cahusac 2 , Yahya A Mohzari 3 , Reem F Bamogaddam 3 , Mashael Alfaifi 3 , Maya Mathew 3 , Bashayer F Alrumayyan 1 , Basmah F Alqahtani 1 , Amjad Alshammari 1 , Kholud AlNekhilan 1 , Aljawharah Binrokan 1 , Khalil Alamri 1 , Abdullah Alshahrani 1 , Safar Alshahrani 1 , Ahmad S Alanazi 1 , Batool M Alhassan 4 , Ali Alsaeed 5 , Wedad Almutairi 6 , Asma Albujaidy 7 , Lama AlJuaid 8 , Ziyad S Almalki 9 , Nehad Ahmed 9 , Hamdan N Alajami 3 , Hala M Aljishi 10 , Mohammed Alsheef 11 , Saleh A Alajlan 12 , Faisal Almutairi 13 , Atheer Alsirhani 14 , Manayer Alotaibi 14 , Melaf A Aljaber 14 , Hammam A Bahammam 15 , Hussain Aldandan 16 , Abdulaziz S Almulhim 17 , Ivo Abraham 18 , Ahmad Alamer 9 18



    Affiliations

    Abstract

    Introduction: Thrombotic complications of coronavirus disease 2019 (COVID-19) have received considerable attention. Although numerous conflicting findings have compared escalated thromboprophylaxis doses with a standard dose to prevent thrombosis, there is a paucity of literature comparing clinical outcomes in three different anticoagulation dosing regimens. Thus, we investigated the effectiveness and safety profiles of standard, intermediate, and high-anti-coagulation dosing strategies in COVID-19 critically ill patients.
    Methodology: This retrospective multicenter cohort study of intensive care unit (ICU) patients from the period of April 2020 to August 2021 in four Saudi Arabian centers. Inclusion criteria were age ≥ 18 years, diagnosis with severe or critical COVID-19 infection, and receiving prophylactic anticoagulant dose within 24-48 h of ICU admission. The primary endpoint was a composite of thrombotic events, with mortality rate and minor or major bleeding serving as secondary endpoints. We applied survival analyses with a matching weights procedure to control for confounding variables in the three arms.
    Results: A total of 811 patient records were reviewed, with 551 (standard-dose = 192, intermediate-dose = 180, and high-dose = 179) included in the analysis. After using weights matching, we found that the standard-dose group was not associated with an increase in the composite thrombotic events endpoint when compared to the intermediate-dose group {19.8 vs. 25%; adjusted hazard ratio (aHR) =1.46, [95% confidence of interval (CI), 0.94-2.26]} or when compared to high-dose group [19.8 vs. 24%; aHR = 1.22 (95% CI, 0.88-1.72)]. Also, there were no statistically significant differences in overall in-hospital mortality between the standard-dose and the intermediate-dose group [51 vs. 53.4%; aHR = 1.4 (95% CI, 0.88-2.33)] or standard-dose and high-dose group [51 vs. 61.1%; aHR = 1.3 (95% CI, 0.83-2.20)]. Moreover, the risk of major bleeding was comparable in all three groups [standard vs. intermediate: 4.8 vs. 2.8%; aHR = 0.8 (95% CI, 0.23-2.74); standard vs. high: 4.8 vs. 9%; aHR = 2.1 (95% CI, 0.79-5.80)]. However, intermediate-dose and high-dose were both associated with an increase in minor bleeding incidence with aHR = 2.9 (95% CI, 1.26-6.80) and aHR = 3.9 (95% CI, 1.73-8.76), respectively.
    Conclusion: Among COVID-19 patients admitted to the ICU, the three dosing regimens did not significantly affect the composite of thrombotic events and mortality. Compared with the standard-dose regimen, intermediate and high-dosing thromboprophylaxis were associated with a higher risk of minor but not major bleeding. Thus, these data recommend a standard dose as the preferred regimen.

    Keywords: COVID-19; critically ill patients; mortality; thromboprophylaxis; thromboprophylaxis doses.

Working...
X