Abstract
Objectives: To compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Design: An observational study.
Setting: At the intensive care unit of a university hospital.
Participants and interventions: Critically ill patients with a SARS-CoV-2 infection receiving full anticoagulation with heparin or bivalirudin.
Measurements and main results: Twenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group having higher mortality risk scores (SAPS II 60 ± 16 v 39 ±7, p < 0.001) and a higher need for extracorporeal support compared to the heparin group, hospital mortality was comparable (57% v 45, p = 0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% v 40%, p = 0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation; in addition to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in the bleeding rate was observed (65% v 35%, p = 0.08).
Conclusions: Although heparin is the most used anticoagulant in the intensive care setting, bivalirudin-based anticoagulation was safe and effective in a cohort of critically ill patients with SARS-CoV-2. Bivalirudin may be given full consideration as an anticoagulation strategy for critically ill patients with SARS-CoV-2, especially in those with thrombocytopenia and on extracorporeal support.
Keywords: SARS-CoV-2 infection; anticoagulation; bivalirudin; critical care; extracorporeal membrane oxygenation.
【저자키워드】 Critical care, anticoagulation, SARS-COV-2 infection, extracorporeal membrane oxygenation, bivalirudin, 【초록키워드】 SARS-CoV-2, coronavirus, Mortality, intensive care, hospital, Infection, extracorporeal membrane oxygenation, Cohort, Patient, bleeding, Critical, Anticoagulant, mortality risk, Safe, intravenous, Support, Critically ill patient, acute respiratory syndrome, university hospital, no difference, participant, subgroup analysis, measurement, effective, thrombotic complication, Occurrence, addition, receiving, comparable, bleeding event, patients treated, thromboembolic complication, 【제목키워드】 SARS-CoV-2, Strategy, Direct, role, Ill,