| Title: |
Impact of High-Dose Prophylactic Anticoagulation in Critically Ill Patients With COVID-19 Pneumonia |
| Authors: |
Tacquard, Charles; Mansour, Alexandre; Godon, Alexandre; Godet, Julien; Poissy, Julien; Huet Garrigue, Delphine; Kipnis, Eric; Hamada, Sophie Rym; Mertes, Paul Michel; Steib, Annick; Ulliel-Roche, Mathilde; Bouhemad, Belaid; Nguyen, Maxime; Reizine, Florian; Gouin-Thibault, Isabelle; Besse, Marie Charlotte; Collercandy, Nived; Mankikian, Stefan; Levy, Jerrold H.; Gruel, Yves; Albaladejo, Pierre; Susen, Sophie; Godier, Anne |
| Contributors: |
Université de Lille; CNRS; Centre Hospitalier Universitaire Strasbourg CHU Strasbourg; Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Ponchaillou; Université de Rennes UR; Centre Hospitalier Universitaire CHU Grenoble CHUGA; Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576; 425779|||Centre Hospitalier Régional Universitaire Lille CHRU Lille; 425779|||Centre Hospitalier Régional Universitaire CHU Lille CHRU Lille (VALID); Centre d'Infection et d'Immunité de Lille (CIIL) - U1019 - UMR 9017; Hôpital Européen Georges Pompidou APHP HEGP; Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand CHU Dijon; Lipides - Nutrition - Cancer Dijon - U1231 LNC; CHU Trousseau Tours; Duke University Durham |
| Publisher Information: |
American College of Chest Physicians |
| Publication Year: |
2022 |
| Collection: |
LillOA (Lille Open Archive - Université de Lille) |
| Subject Terms: |
anticoagulation; bleeding; COVID-19; thrombosis |
| Description: |
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. ; 159;6 |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/octet-stream |
| Language: |
English |
| Relation: |
416763fd-c8d5-46de-949a-b506ab46ba59; Chest; http://hdl.handle.net/20.500.12210/59577 |
| Availability: |
https://hdl.handle.net/20.500.12210/59577 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.D5E252B5 |
| Database: |
BASE |