tetano
Editor, Senior Moderator
Sci Rep
. 2025 Mar 25;15(1):10321.
doi: 10.1038/s41598-024-77858-w. Assessing differential application of thromboprophylaxis regimes related to risk of pulmonary embolism and mortality in COVID-19 patients through instrumental variable analysis
Linda Nab[SUP] #[/SUP][SUP] 1 [/SUP], Chantal Visser[SUP] #[/SUP][SUP] 2 [/SUP], Bas C T van Bussel[SUP] 3 4 [/SUP], Albertus Beishuizen[SUP] 5 [/SUP], Remy H H Bemelmans[SUP] 6 [/SUP], Hugo Ten Cate[SUP] 4 7 8 9 [/SUP], F Nanne Croles[SUP] 10 [/SUP], Coen van Guldener[SUP] 11 [/SUP], C Peter C de Jager[SUP] 12 [/SUP], Menno V Huisman[SUP] 13 14 [/SUP], Marten R Nijziel[SUP] 15 [/SUP], Pieter W Kamphuisen[SUP] 16 17 [/SUP], Frederikus A Klok[SUP] 13 [/SUP], Stephanie C E Koster[SUP] 18 [/SUP], Nuray Kuşadasi[SUP] 19 [/SUP], Karina Meijer[SUP] 20 [/SUP], Corstiaan A den Uil[SUP] 21 22 23 [/SUP], Roger E G Schutgens[SUP] 24 [/SUP], Frank Stam[SUP] 25 [/SUP], Alexander P J Vlaar[SUP] 26 [/SUP], Eline A Vlot[SUP] 27 [/SUP], Marijke P M Linschoten[SUP] 28 [/SUP], Folkert W Asselbergs[SUP] 29 30 [/SUP], Marieke J H A Kruip[SUP] 2 [/SUP], Saskia le Cessie[SUP] 1 31 [/SUP], Suzanne C Cannegieter[SUP] 32 [/SUP]; Dutch Covid and Thrombosis Coalition & the CAPACITY-COVID collaborative consortium
Collaborators, Affiliations
Thrombotic complications are common in Coronavirus disease 2019 (COVID-19) patients, with pulmonary embolism (PE) being the most frequent. Randomised trials have provided inconclusive results on the optimal dosage of thromboprophylaxis in critically ill COVID-19 patients. We utilized data from the multicentre CAPACITY-COVID patient registry to assess the effect of differential application of Low Molecular Weight Heparin (LMWH) dose protocols on PE and in-hospital mortality risk in critically ill COVID-19 patients. An instrumental variable analysis was performed to estimate the intention-to-treat effect, utilizing differences in thromboprophylaxis prescribing behaviour between hospitals. We included 939 patients with PCR confirmed SARS-CoV-2 infection from 34 hospitals. Two-hundred-and-one patients (21%) developed a PE. The adjusted cause-specific HR of PE was 0.92 (95% CI: 0.73-1.16) per doubling of LMWH dose. The adjusted cause-specific HR for in-hospital mortality was 0.82 (95% CI: 0.65-1.02) per doubling of LMWH dose. This dose-response relationship was shown to be non-linear. To conclude, this study did not find evidence for an effect of LMWH dose on the risk of PE, but suggested a non-linear decreased risk of in-hospital mortality for higher doses of LMWH. However, uncertainty remains, and the dose-response relationship between LMWH dose and in-hospital mortality needs further investigation in well-designed studies.
Keywords: COVID-19; Dose–response relationship; Drug; Heparin; Hospital mortality; Low-molecular-weight; Pulmonary embolism.
. 2025 Mar 25;15(1):10321.
doi: 10.1038/s41598-024-77858-w. Assessing differential application of thromboprophylaxis regimes related to risk of pulmonary embolism and mortality in COVID-19 patients through instrumental variable analysis
Linda Nab[SUP] #[/SUP][SUP] 1 [/SUP], Chantal Visser[SUP] #[/SUP][SUP] 2 [/SUP], Bas C T van Bussel[SUP] 3 4 [/SUP], Albertus Beishuizen[SUP] 5 [/SUP], Remy H H Bemelmans[SUP] 6 [/SUP], Hugo Ten Cate[SUP] 4 7 8 9 [/SUP], F Nanne Croles[SUP] 10 [/SUP], Coen van Guldener[SUP] 11 [/SUP], C Peter C de Jager[SUP] 12 [/SUP], Menno V Huisman[SUP] 13 14 [/SUP], Marten R Nijziel[SUP] 15 [/SUP], Pieter W Kamphuisen[SUP] 16 17 [/SUP], Frederikus A Klok[SUP] 13 [/SUP], Stephanie C E Koster[SUP] 18 [/SUP], Nuray Kuşadasi[SUP] 19 [/SUP], Karina Meijer[SUP] 20 [/SUP], Corstiaan A den Uil[SUP] 21 22 23 [/SUP], Roger E G Schutgens[SUP] 24 [/SUP], Frank Stam[SUP] 25 [/SUP], Alexander P J Vlaar[SUP] 26 [/SUP], Eline A Vlot[SUP] 27 [/SUP], Marijke P M Linschoten[SUP] 28 [/SUP], Folkert W Asselbergs[SUP] 29 30 [/SUP], Marieke J H A Kruip[SUP] 2 [/SUP], Saskia le Cessie[SUP] 1 31 [/SUP], Suzanne C Cannegieter[SUP] 32 [/SUP]; Dutch Covid and Thrombosis Coalition & the CAPACITY-COVID collaborative consortium
Collaborators, Affiliations
- PMID: 40133355
- DOI: 10.1038/s41598-024-77858-w
Thrombotic complications are common in Coronavirus disease 2019 (COVID-19) patients, with pulmonary embolism (PE) being the most frequent. Randomised trials have provided inconclusive results on the optimal dosage of thromboprophylaxis in critically ill COVID-19 patients. We utilized data from the multicentre CAPACITY-COVID patient registry to assess the effect of differential application of Low Molecular Weight Heparin (LMWH) dose protocols on PE and in-hospital mortality risk in critically ill COVID-19 patients. An instrumental variable analysis was performed to estimate the intention-to-treat effect, utilizing differences in thromboprophylaxis prescribing behaviour between hospitals. We included 939 patients with PCR confirmed SARS-CoV-2 infection from 34 hospitals. Two-hundred-and-one patients (21%) developed a PE. The adjusted cause-specific HR of PE was 0.92 (95% CI: 0.73-1.16) per doubling of LMWH dose. The adjusted cause-specific HR for in-hospital mortality was 0.82 (95% CI: 0.65-1.02) per doubling of LMWH dose. This dose-response relationship was shown to be non-linear. To conclude, this study did not find evidence for an effect of LMWH dose on the risk of PE, but suggested a non-linear decreased risk of in-hospital mortality for higher doses of LMWH. However, uncertainty remains, and the dose-response relationship between LMWH dose and in-hospital mortality needs further investigation in well-designed studies.
Keywords: COVID-19; Dose–response relationship; Drug; Heparin; Hospital mortality; Low-molecular-weight; Pulmonary embolism.