ABSTRACT
ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.
Subject(s)
Humans , Adult , Aged , Venous Thromboembolism , COVID-19 , Heparin, Low-Molecular-Weight/therapeutic use , SARS-CoV-2 , Inpatients , Anticoagulants/therapeutic useABSTRACT
CONTEXT AND OBJECTIVE: Many clinical investigations use generic and/or specific questionnaires to obtain information about participants and patients. There is disagreement about whether the administration method can affect the results. The aim here was to determine whether, among patients with intermittent claudication (IC), there are differences in the Walking Impairment Questionnaire (WIQ) and European Quality of Life-5 Dimension (EQ-5D) scores with regard to: 1) the questionnaire administration method (self-administration versus face-to-face interview); and 2) the type of interviewer (vascular surgeon, VS, versus general practitioner, GP). DESIGN AND SETTING: Cross-sectional observational multicenter epidemiological study carried out within the Spanish National Health Service. METHODS: 1,641 evaluable patients with IC firstly completed the WIQ and EQ-5D questionnaires and then were interviewed by their doctor on the same day. Pearson correlations and Chi-square tests were used. RESULTS: There was a strong correlation (r > 0.800; P < 0.001) between the two methods of administering the WIQ and EQ-5D questionnaires, and between the VS and GP groups. Likewise, there was a high level of concordance (P > 0.05) between the different dimensions of the WIQ-distance and EQ-5D (self-administration versus face-to-face) in the VS and GP groups. CONCLUSION: There was no difference between the different methods of administering the WIQ and EQ-5D questionnaires, among the patients with IC. Similarly, the two types of interviewers (VS or GP) were equally valid. Therefore, it seems unnecessary to expend effort to administer these questionnaires by interview, in studies on IC.
RESUMO CONTEXTO E OBJETIVO: Muitas investigações clínicas usam questionários genéricos e/ou específicos para obter informações sobre os participantes e pacientes. Não se sabe se o modo de administração pode afetar os resultados. O objetivo foi determinar se, nos pacientes com claudicação intermitente (CI), existem diferenças nas pontuações do Walking Impairment Questionnaire (WIQ) e do European Quality of Life-5 Dimension (EQ-5D) no que diz respeito a: 1) a forma de administrar o questionário (autoadministrado versus entrevista presencial); e 2) o tipo de entrevistador: cirurgião vascular (CV) ou médico generalista (MG). TIPO DE ESTUDIO E LOCAL: Estudo epidemiológico observacional, transversal, multicêntrico realizado no Serviço Nacional de Saúde espanhol. METODO: 1.641 pacientes avaliáveis com CI completaram inicialmente o WIQ e questionários EQ-5, e depois, no mesmo dia, foram entrevistados pelo seu médico. Foram utilizados correlações de Pearson e testes de qui-quadrado. RESULTADOS: Houve forte correlação (r > 0,800; P < 0,001) entre os dois métodos de administração do WIQ e EQ-5D; e entre os grupos CV e MG. Também houve alto nível de concordância (P > 0,05) entre as diferentes dimensões do WIQ-distância e EQ-5D (autoadministrado versus entrevista presencial), nos grupos CV e MG. Conclusão: Em pacientes com CI, não há diferenças entre as diferentes formas de administrar os questionários WIQ e EQ-5D. Da mesma forma, os dois tipos de entrevistador (CV ou MG) foram igualmente válidos. Portanto, não parece necessário despender esforço para administrar esses questionários através de entrevista, em estudos de CI.