Abstract
Background: Because of the high risk of thrombotic complications (TCs) during SARS-CoV-2 infection, several scientific societies have proposed to increase the dose of preventive anticoagulation, although arguments in favor of this strategy are inconsistent.
Research question: What is the incidence of TC in critically ill patients with COVID-19 and what is the relationship between the dose of anticoagulant therapy and the incidence of TC?
Study design and methods: All consecutive patients referred to eight French ICUs for COVID-19 were included in this observational study. Clinical and laboratory data were collected from ICU admission to day 14, including anticoagulation status and thrombotic and hemorrhagic events. The effect of high-dose prophylactic anticoagulation (either at intermediate or equivalent to therapeutic dose), defined using a standardized protocol of classification, was assessed using a time-varying exposure model using inverse probability of treatment weight.
Results: Of 538 patients included, 104 patients experienced a total of 122 TCs with an incidence of 22.7% (95% CI, 19.2%-26.3%). Pulmonary embolism accounted for 52% of the recorded TCs. High-dose prophylactic anticoagulation was associated with a significant reduced risk of TC (hazard ratio, 0.81; 95% CI, 0.66-0.99) without increasing the risk of bleeding (HR, 1.11; 95% CI, 0.70-1.75).
Interpretation: High-dose prophylactic anticoagulation is associated with a reduction in thrombotic complications in critically ill patients with COVID-19 without an increased risk of hemorrhage. Randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results.
Trial registry: ClinicalTrials.gov; No.: NCT04405869 ; URL: www.clinicaltrials.gov.
Keywords: COVID-19; anticoagulation; bleeding; thrombosis.
【저자키워드】 COVID-19, anticoagulation, thrombosis, bleeding, 【초록키워드】 Treatment, thrombosis, SARS-COV-2 infection, risk, Prophylactic, ICU, Prophylaxis, Probability, clinical, Pulmonary embolism, therapeutic, Patient, ICU admission, Controlled trial, incidence, Anticoagulant, dose, hemorrhage, high risk, anticoagulant therapy, Critically ill patient, High-dose, 95% CI, increased risk, reduced risk, hazard ratio, laboratory data, favor, thrombotic, French, standardized protocol, thrombotic complication, defined, collected, eight, accounted, reduction in, recorded, consecutive patient, hemorrhagic events, with COVID-19, 【제목키워드】 Impact, Ill,