학술논문
Anticoagulation strategy and safety in critically ill COVID-19 patients: a French retrospective multicentre study
Document Type
article
Author
Pauline Lamouche-Wilquin; Léa Perrin; Morgane Pere; Matthieu Raymond; Pierre Asfar; Cedric Darreau; Florian Reizine; Gwenhaël Colin; Agathe Delbove; Johann Auchabie; Baptiste Hourmant; Aurélien Frérou; Béatrice La Combe; Jean Morin; Pierre Kergoat; Julien Lorber; Pierre-Yves Egreteau; Jérome Souchard; Emmanuel Canet; Jean-Baptiste Lascarrou
Source
Thrombosis Journal, Vol 21, Iss 1, Pp 1-10 (2023)
Subject
Language
English
ISSN
1477-9560
Abstract
Abstract Background Patients with critical illness due to COVID-19 exhibit increased coagulability associated with a high risk of venous thrombo-embolism (VTE). Data on prophylactic anticoagulation for these patients are limited and conflicting. The purpose of this study was to evaluate whether intermediate-dose prophylactic anticoagulation in patients with COVID-19 requiring ICU admission was associated with better outcomes compared to standard-dose prophylactic anticoagulation. Methods We retrospectively included adults admitted with severe COVID-19 to any of 15 ICUs, in 2020 or 2021. We compared the groups given intermediate-dose vs. standard-dose prophylactic anticoagulation. The primary outcome was all-cause day-90 mortality. Secondary outcomes were VTE (pulmonary embolism or deep vein thrombosis), ICU stay length, and adverse effects of anticoagulation. Results Of 1174 included patients (mean age, 63 years), 399 received standard-dose and 775 intermediate-dose prophylactic anticoagulation. Of the 211 patients who died within 90 days, 86 (21%) received intermediate and 125 (16%) standard doses. After adjustment on early corticosteroid therapy and critical illness severity, there were no significant between-group differences in day-90 mortality (hazard ratio [HR], 0.73; 95%CI, 0.52–1.04; p = 0.09) or ICU stay length (HR, 0.93; 95%CI, 0.79–1.10; p = 0.38). Intermediate-dose anticoagulation was significantly associated with fewer VTE events (HR, 0.55; 95%CI, 0.38–0.80; p