tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Peter Cahusac[SUP] 2 [/SUP], Yahya A Mohzari[SUP] 3 [/SUP], Reem F Bamogaddam[SUP] 3 [/SUP], Mashael Alfaifi[SUP] 3 [/SUP], Maya Mathew[SUP] 3 [/SUP], Bashayer F Alrumayyan[SUP] 1 [/SUP], Basmah F Alqahtani[SUP] 1 [/SUP], Amjad Alshammari[SUP] 1 [/SUP], Kholud AlNekhilan[SUP] 1 [/SUP], Aljawharah Binrokan[SUP] 1 [/SUP], Khalil Alamri[SUP] 1 [/SUP], Abdullah Alshahrani[SUP] 1 [/SUP], Safar Alshahrani[SUP] 1 [/SUP], Ahmad S Alanazi[SUP] 1 [/SUP], Batool M Alhassan[SUP] 4 [/SUP], Ali Alsaeed[SUP] 5 [/SUP], Wedad Almutairi[SUP] 6 [/SUP], Asma Albujaidy[SUP] 7 [/SUP], Lama AlJuaid[SUP] 8 [/SUP], Ziyad S Almalki[SUP] 9 [/SUP], Nehad Ahmed[SUP] 9 [/SUP], Hamdan N Alajami[SUP] 3 [/SUP], Hala M Aljishi[SUP] 10 [/SUP], Mohammed Alsheef[SUP] 11 [/SUP], Saleh A Alajlan[SUP] 12 [/SUP], Faisal Almutairi[SUP] 13 [/SUP], Atheer Alsirhani[SUP] 14 [/SUP], Manayer Alotaibi[SUP] 14 [/SUP], Melaf A Aljaber[SUP] 14 [/SUP], Hammam A Bahammam[SUP] 15 [/SUP], Hussain Aldandan[SUP] 16 [/SUP], Abdulaziz S Almulhim[SUP] 17 [/SUP], Ivo Abraham[SUP] 18 [/SUP], Ahmad Alamer[SUP] 9 18 [/SUP]
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.
. 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[SUP] 1 [/SUP], Peter Cahusac[SUP] 2 [/SUP], Yahya A Mohzari[SUP] 3 [/SUP], Reem F Bamogaddam[SUP] 3 [/SUP], Mashael Alfaifi[SUP] 3 [/SUP], Maya Mathew[SUP] 3 [/SUP], Bashayer F Alrumayyan[SUP] 1 [/SUP], Basmah F Alqahtani[SUP] 1 [/SUP], Amjad Alshammari[SUP] 1 [/SUP], Kholud AlNekhilan[SUP] 1 [/SUP], Aljawharah Binrokan[SUP] 1 [/SUP], Khalil Alamri[SUP] 1 [/SUP], Abdullah Alshahrani[SUP] 1 [/SUP], Safar Alshahrani[SUP] 1 [/SUP], Ahmad S Alanazi[SUP] 1 [/SUP], Batool M Alhassan[SUP] 4 [/SUP], Ali Alsaeed[SUP] 5 [/SUP], Wedad Almutairi[SUP] 6 [/SUP], Asma Albujaidy[SUP] 7 [/SUP], Lama AlJuaid[SUP] 8 [/SUP], Ziyad S Almalki[SUP] 9 [/SUP], Nehad Ahmed[SUP] 9 [/SUP], Hamdan N Alajami[SUP] 3 [/SUP], Hala M Aljishi[SUP] 10 [/SUP], Mohammed Alsheef[SUP] 11 [/SUP], Saleh A Alajlan[SUP] 12 [/SUP], Faisal Almutairi[SUP] 13 [/SUP], Atheer Alsirhani[SUP] 14 [/SUP], Manayer Alotaibi[SUP] 14 [/SUP], Melaf A Aljaber[SUP] 14 [/SUP], Hammam A Bahammam[SUP] 15 [/SUP], Hussain Aldandan[SUP] 16 [/SUP], Abdulaziz S Almulhim[SUP] 17 [/SUP], Ivo Abraham[SUP] 18 [/SUP], Ahmad Alamer[SUP] 9 18 [/SUP]
Affiliations
- PMID: 36051287
- PMCID: PMC9424612
- DOI: 10.3389/fcvm.2022.978420
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.