학술논문
Effect of therapeutic-dose heparin on severe acute kidney injury and death in noncritically ill patients hospitalized for COVID-19: a prespecified secondary analysis of the ACTIV4a and ATTACC randomized trial.
Document Type
Academic Journal
Author
Smilowitz NR; NYU Grossman School of Medicine, New York, New York, USA.; Hade EM; NYU Grossman School of Medicine, New York, New York, USA.; Kornblith LZ; Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA.; Castellucci LA; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; University of Ottawa, Ottawa, Ontario, Canada.; Cushman M; Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.; Farkouh M; Peter Munk Cardiac Centre at University Health Network, Toronto, Ontario, Canada.; University of Toronto, Toronto, Ontario, Canada.; Gong MN; Montefiore Medical Center, Bronx, New York, USA.; Albert Einstein College of Medicine, Bronx, New York, USA.; Heath A; The Hospital for Sick Children, Toronto, Ontario, Canada.; Hunt BJ; Kings College, London, UK.; Kim KS; University of Illinois, Chicago, Illinois, USA.; Kindzelski A; National Heart Lung & Blood Institute, NIH, Bethesda, Maryland, USA.; Lawler P; Peter Munk Cardiac Centre at University Health Network, Toronto, Ontario, Canada.; University of Toronto, Toronto, Ontario, Canada.; Leaf DE; Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA.; Goligher E; University of Toronto, Toronto, Ontario, Canada.; University Health Network, Toronto, Ontario, Canada.; Leifer ES; National Heart Lung & Blood Institute, NIH, Bethesda, Maryland, USA.; McVerry BJ; University of Pittsburgh, Pittsburgh, Pennsylvania, USA.; UPMC, Pittsburgh, Pennsylvania, USA.; Reynolds HR; NYU Grossman School of Medicine, New York, New York, USA.; Zarychanski R; University of Manitoba, Winnipeg, Manitoba, Canada.; CancerCare Manitoba, Winnipeg, Manitoba, Canada.; Hochman JS; NYU Grossman School of Medicine, New York, New York, USA.; Neal MD; University of Pittsburgh, Pittsburgh, Pennsylvania, USA.; UPMC, Pittsburgh, Pennsylvania, USA.; Berger JS; NYU Grossman School of Medicine, New York, New York, USA.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 101703775 Publication Model: eCollection Cited Medium: Internet ISSN: 2475-0379 (Electronic) Linking ISSN: 24750379 NLM ISO Abbreviation: Res Pract Thromb Haemost Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Acute kidney injury (AKI) in patients with COVID-19 is partly mediated by thromboinflammation. In noncritically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support.
Objectives: We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in noncritically ill patients hospitalized for COVID-19.
Methods: We report a prespecified secondary analysis of the ACTIV4a and ATTACC open-label, multiplatform randomized trial of therapeutic-dose heparin vs usual-care pharmacologic thromboprophylaxis on the incidence of severe AKI (≥2-fold increase in serum creatinine or initiation of kidney replacement therapy (KDIGO stage 2 or 3) or all-cause mortality in noncritically ill patients hospitalized for COVID-19. Bayesian statistical models were adjusted for age, sex, D-dimer, enrollment period, country, site, and platform.
Results: Among 1922 enrolled, 23 were excluded due to pre-existing end stage kidney disease and 205 were missing baseline or follow-up creatinine measurements. Severe AKI or death occurred in 4.4% participants assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR]: 0.72; 95% credible interval (CrI): 0.47, 1.10); the posterior probability of superiority for therapeutic-dose heparin (relative risk < 1.0) was 93.6%. Therapeutic-dose heparin was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs 4.6%; aRR: 0.64; 95% CrI: 0.40, 0.99) compared to thromboprophylaxis.
Conclusion: Therapeutic-dose heparin was associated with a high probability of superiority to reduce the incidence of in-hospital severe AKI or death in patients hospitalized for COVID-19.
(© 2023 Published by Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis.)
Objectives: We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in noncritically ill patients hospitalized for COVID-19.
Methods: We report a prespecified secondary analysis of the ACTIV4a and ATTACC open-label, multiplatform randomized trial of therapeutic-dose heparin vs usual-care pharmacologic thromboprophylaxis on the incidence of severe AKI (≥2-fold increase in serum creatinine or initiation of kidney replacement therapy (KDIGO stage 2 or 3) or all-cause mortality in noncritically ill patients hospitalized for COVID-19. Bayesian statistical models were adjusted for age, sex, D-dimer, enrollment period, country, site, and platform.
Results: Among 1922 enrolled, 23 were excluded due to pre-existing end stage kidney disease and 205 were missing baseline or follow-up creatinine measurements. Severe AKI or death occurred in 4.4% participants assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR]: 0.72; 95% credible interval (CrI): 0.47, 1.10); the posterior probability of superiority for therapeutic-dose heparin (relative risk < 1.0) was 93.6%. Therapeutic-dose heparin was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs 4.6%; aRR: 0.64; 95% CrI: 0.40, 0.99) compared to thromboprophylaxis.
Conclusion: Therapeutic-dose heparin was associated with a high probability of superiority to reduce the incidence of in-hospital severe AKI or death in patients hospitalized for COVID-19.
(© 2023 Published by Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis.)