tetano
Editor, Senior Moderator
J Cardiothorac Vasc Anesth
. 2022 Mar 8;S1053-0770(22)00182-3.
doi: 10.1053/j.jvca.2022.03.004. Online ahead of print.
Anticoagulation Strategies in Critically Ill Patients With SARS-CoV-2 Infection: The Role of Direct Thrombin Inhibitors
Marina Pieri[SUP] 1 [/SUP], Luisa Quaggiotti[SUP] 1 [/SUP], Evgeny Fominskiy[SUP] 1 [/SUP], Giovanni Landoni[SUP] 2 [/SUP], Maria Grazia Calabrò[SUP] 1 [/SUP], Silvia Ajello[SUP] 1 [/SUP], Matteo Aldo Bonizzoni[SUP] 1 [/SUP], Alessandro Belletti[SUP] 1 [/SUP], Anna Mara Scandroglio[SUP] 3 [/SUP]
Affiliations
Abstract
Objectives: To compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Design: An observational study.
Setting: At the intensive care unit of a university hospital.
Participants and interventions: Critically ill patients with a SARS-CoV-2 infection receiving full anticoagulation with heparin or bivalirudin.
Measurements and main results: Twenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group having higher mortality risk scores (SAPS II 60 ± 16 v 39 ±7, p < 0.001) and a higher need for extracorporeal support compared to the heparin group, hospital mortality was comparable (57% v 45, p = 0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% v 40%, p = 0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation; in addition to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in the bleeding rate was observed (65% v 35%, p = 0.08).
Conclusions: Although heparin is the most used anticoagulant in the intensive care setting, bivalirudin-based anticoagulation was safe and effective in a cohort of critically ill patients with SARS-CoV-2. Bivalirudin may be given full consideration as an anticoagulation strategy for critically ill patients with SARS-CoV-2, especially in those with thrombocytopenia and on extracorporeal support.
Keywords: SARS-CoV-2 infection; anticoagulation; bivalirudin; critical care; extracorporeal membrane oxygenation.
. 2022 Mar 8;S1053-0770(22)00182-3.
doi: 10.1053/j.jvca.2022.03.004. Online ahead of print.
Anticoagulation Strategies in Critically Ill Patients With SARS-CoV-2 Infection: The Role of Direct Thrombin Inhibitors
Marina Pieri[SUP] 1 [/SUP], Luisa Quaggiotti[SUP] 1 [/SUP], Evgeny Fominskiy[SUP] 1 [/SUP], Giovanni Landoni[SUP] 2 [/SUP], Maria Grazia Calabrò[SUP] 1 [/SUP], Silvia Ajello[SUP] 1 [/SUP], Matteo Aldo Bonizzoni[SUP] 1 [/SUP], Alessandro Belletti[SUP] 1 [/SUP], Anna Mara Scandroglio[SUP] 3 [/SUP]
Affiliations
- PMID: 35428549
- DOI: 10.1053/j.jvca.2022.03.004
Abstract
Objectives: To compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Design: An observational study.
Setting: At the intensive care unit of a university hospital.
Participants and interventions: Critically ill patients with a SARS-CoV-2 infection receiving full anticoagulation with heparin or bivalirudin.
Measurements and main results: Twenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group having higher mortality risk scores (SAPS II 60 ± 16 v 39 ±7, p < 0.001) and a higher need for extracorporeal support compared to the heparin group, hospital mortality was comparable (57% v 45, p = 0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% v 40%, p = 0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation; in addition to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in the bleeding rate was observed (65% v 35%, p = 0.08).
Conclusions: Although heparin is the most used anticoagulant in the intensive care setting, bivalirudin-based anticoagulation was safe and effective in a cohort of critically ill patients with SARS-CoV-2. Bivalirudin may be given full consideration as an anticoagulation strategy for critically ill patients with SARS-CoV-2, especially in those with thrombocytopenia and on extracorporeal support.
Keywords: SARS-CoV-2 infection; anticoagulation; bivalirudin; critical care; extracorporeal membrane oxygenation.