tetano
Editor, Senior Moderator
Saudi Pharm J
. 2022 Feb 3.
doi: 10.1016/j.jsps.2022.01.022. Online ahead of print.
Comparison Between Standard Vs. Escalated Dose Venous Thromboembolism (VTE) Prophylaxis in Critically Ill Patients with COVID-19: A Two centers, Observational Study
Ohoud Aljuhani[SUP] 1 [/SUP], Khalid Alsulaiman[SUP] 2 3 4 [/SUP], Awattif Hafiz[SUP] 1 [/SUP], Khalid Eljaaly[SUP] 1 5 [/SUP], Aisha Alharbi[SUP] 6 [/SUP], Rahma Algarni[SUP] 6 [/SUP], Sarah Al Homaid[SUP] 3 [/SUP], Khawla Al Qahtani[SUP] 3 [/SUP], Tareq Alsulaiman[SUP] 7 [/SUP], Ramesh Vishwakarma[SUP] 4 [/SUP], Ghassan Al Ghamdi[SUP] 4 8 9 [/SUP], Mai Alalawi[SUP] 10 [/SUP], Ghazwa B Korayem[SUP] 11 [/SUP]
Affiliations
Abstract
Introduction: The risk of mortality in patients with COVID-19 was found to be significantly higher in patients who experienced thromboembolic events. Thus, several guidelines recommend using prophylactic anticoagulants in all COVID-19 hospitalized patients. However, there is uncertainty about the appropriate dosing regimen and safety of anticoagulation in critically ill COVID-19 patients. Thus, the study aims to compare the effectiveness and safety of standard and escalated dose pharmacological VTE prophylaxis in critically ill patients with COVID-19.
Methods: A two centers retrospective cohort study including critically ill patients aged ≥ 18-years with confirmed COVID-19 admitted to the ICUs at two tertiary hospitals in Saudi Arabia from March 1st, 2020, until January 31st, 2021. Patients who received either Enoxaparin 40 mg daily or UFH 5000 Unit three times daily were grouped under the "standard dose VTE prophylaxis or higher than standard dose but not as treatment dose "escalated VTE prophylaxis dose" The primary outcome was thrombosis, and the secondary outcomes included ICU-related complication (s).
Results: A total of 758 patients were screened; 565 patients were included in the study. We matched 352 patients using propensity score matching (1:1). The differences in venous thromboembolism (OR 0.75; 95% CI 0.16-3.38; P =0.70) and any case of thrombosis during ICU were more likely to occur (OR 1.22;95%CI 0.52-2.86; P=0.64). In contrast, minor bleeding was associated with the use of escalated VTE prophylaxis dose (OR 3.39; 95% CI 1.08-10.61; P=0.04). There was no difference in the 30-day mortality nor in-hospital mortality between the two groups (HR 1.17;95%CI0.79-1.73; P=0.43 and (HR 1.08;95%CI 0.76-1.53; P=0.83, respectively.
Conclusion: Escalated-dose pharmacological VTE prophylaxis in critically ill patients with COVID-19 was not associated with VTE, thrombosis, or mortality benefits but led to an increased risk of minor bleeding. This study supports previous study findings regarding optimal dosing VTE pharmacological prophylaxis regimen for critically ill patients with COVID-19.
Keywords: COVID-19; COVID-19, Coronavirus disease; Critically ill; DVT prophylaxis; Enoxaparin; Heparin; ICUs, Intensive care units; Intensive Care Units (ICUs); LOS, Length of Stay; MV, Mechanical ventilation; SARS-Cov-2; VTE prophylaxis; VTE, Venous thromboembolism.
. 2022 Feb 3.
doi: 10.1016/j.jsps.2022.01.022. Online ahead of print.
Comparison Between Standard Vs. Escalated Dose Venous Thromboembolism (VTE) Prophylaxis in Critically Ill Patients with COVID-19: A Two centers, Observational Study
Ohoud Aljuhani[SUP] 1 [/SUP], Khalid Alsulaiman[SUP] 2 3 4 [/SUP], Awattif Hafiz[SUP] 1 [/SUP], Khalid Eljaaly[SUP] 1 5 [/SUP], Aisha Alharbi[SUP] 6 [/SUP], Rahma Algarni[SUP] 6 [/SUP], Sarah Al Homaid[SUP] 3 [/SUP], Khawla Al Qahtani[SUP] 3 [/SUP], Tareq Alsulaiman[SUP] 7 [/SUP], Ramesh Vishwakarma[SUP] 4 [/SUP], Ghassan Al Ghamdi[SUP] 4 8 9 [/SUP], Mai Alalawi[SUP] 10 [/SUP], Ghazwa B Korayem[SUP] 11 [/SUP]
Affiliations
- PMID: 35136364
- PMCID: PMC8812085
- DOI: 10.1016/j.jsps.2022.01.022
Abstract
Introduction: The risk of mortality in patients with COVID-19 was found to be significantly higher in patients who experienced thromboembolic events. Thus, several guidelines recommend using prophylactic anticoagulants in all COVID-19 hospitalized patients. However, there is uncertainty about the appropriate dosing regimen and safety of anticoagulation in critically ill COVID-19 patients. Thus, the study aims to compare the effectiveness and safety of standard and escalated dose pharmacological VTE prophylaxis in critically ill patients with COVID-19.
Methods: A two centers retrospective cohort study including critically ill patients aged ≥ 18-years with confirmed COVID-19 admitted to the ICUs at two tertiary hospitals in Saudi Arabia from March 1st, 2020, until January 31st, 2021. Patients who received either Enoxaparin 40 mg daily or UFH 5000 Unit three times daily were grouped under the "standard dose VTE prophylaxis or higher than standard dose but not as treatment dose "escalated VTE prophylaxis dose" The primary outcome was thrombosis, and the secondary outcomes included ICU-related complication (s).
Results: A total of 758 patients were screened; 565 patients were included in the study. We matched 352 patients using propensity score matching (1:1). The differences in venous thromboembolism (OR 0.75; 95% CI 0.16-3.38; P =0.70) and any case of thrombosis during ICU were more likely to occur (OR 1.22;95%CI 0.52-2.86; P=0.64). In contrast, minor bleeding was associated with the use of escalated VTE prophylaxis dose (OR 3.39; 95% CI 1.08-10.61; P=0.04). There was no difference in the 30-day mortality nor in-hospital mortality between the two groups (HR 1.17;95%CI0.79-1.73; P=0.43 and (HR 1.08;95%CI 0.76-1.53; P=0.83, respectively.
Conclusion: Escalated-dose pharmacological VTE prophylaxis in critically ill patients with COVID-19 was not associated with VTE, thrombosis, or mortality benefits but led to an increased risk of minor bleeding. This study supports previous study findings regarding optimal dosing VTE pharmacological prophylaxis regimen for critically ill patients with COVID-19.
Keywords: COVID-19; COVID-19, Coronavirus disease; Critically ill; DVT prophylaxis; Enoxaparin; Heparin; ICUs, Intensive care units; Intensive Care Units (ICUs); LOS, Length of Stay; MV, Mechanical ventilation; SARS-Cov-2; VTE prophylaxis; VTE, Venous thromboembolism.