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Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19.
Al-Samkari, Hanny; Gupta, Shruti; Leaf, Rebecca Karp; Wang, Wei; Rosovsky, Rachel P; Brenner, Samantha K; Hayek, Salim S; Berlin, Hanna; Kapoor, Rajat; Shaefi, Shahzad; Melamed, Michal L; Sutherland, Anne; Radbel, Jared; Green, Adam; Garibaldi, Brian T; Srivastava, Anand; Leonberg-Yoo, Amanda; Shehata, Alexandre M; Flythe, Jennifer E; Rashidi, Arash; Goyal, Nitender; Chan, Lili; Mathews, Kusum S; Hedayati, S Susan; Dy, Rajany; Toth-Manikowski, Stephanie M; Zhang, Jingjing; Mallappallil, Mary; Redfern, Roberta E; Bansal, Amar D; Short, Samuel A P; Vangel, Mark G; Admon, Andrew J; Semler, Matthew W; Bauer, Kenneth A; Hernán, Miguel A; Leaf, David E.
  • Al-Samkari H; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (H.A., R.K.L., R.P.R.).
  • Gupta S; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.G., D.E.L.).
  • Leaf RK; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (H.A., R.K.L., R.P.R.).
  • Wang W; Brigham and Women's Hospital, Boston, Massachusetts (W.W.).
  • Rosovsky RP; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (H.A., R.K.L., R.P.R.).
  • Brenner SK; Heart and Vascular Hospital, Hackensack Meridian Health Hackensack University Medical Center, Hackensack, New Jersey (S.K.B.).
  • Hayek SS; University of Michigan Medical Center, Ann Arbor, Michigan (S.S.H., H.B.).
  • Berlin H; University of Michigan Medical Center, Ann Arbor, Michigan (S.S.H., H.B.).
  • Kapoor R; Indiana University School of Medicine, Indianapolis, Indiana (R.K.).
  • Shaefi S; Beth Israel Deaconess Medical Center, Boston, Massachusetts (S.S.).
  • Melamed ML; Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.L.M.).
  • Sutherland A; Rutgers New Jersey Medical School, Newark, New Jersey (A.S.).
  • Radbel J; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.R.).
  • Green A; Cooper University Health Care, Camden, New Jersey (A.G.).
  • Garibaldi BT; Johns Hopkins School of Medicine, Baltimore, Maryland (B.T.G.).
  • Srivastava A; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, and Northwestern University Feinberg School of Medicine, Chicago, Illinois (A.S.).
  • Leonberg-Yoo A; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.L.).
  • Shehata AM; Hackensack Meridian Health Mountainside Medical Center, Glen Ridge, New Jersey (A.M.S.).
  • Flythe JE; University of North Carolina Kidney Center, UNC School of Medicine, and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina (J.E.F.).
  • Rashidi A; University Hospitals Cleveland Medical Center, Cleveland, Ohio (A.R.).
  • Goyal N; Tufts Medical Center, Boston, Massachusetts (N.G.).
  • Chan L; Icahn School of Medicine at Mount Sinai, New York, New York (L.C., K.S.M.).
  • Mathews KS; Icahn School of Medicine at Mount Sinai, New York, New York (L.C., K.S.M.).
  • Hedayati SS; University of Texas Southwestern Medical Center, Dallas, Texas (S.S.H.).
  • Dy R; University Medical Center of Southern Nevada Hospital, University of Nevada, Las Vegas, Nevada (R.D.).
  • Toth-Manikowski SM; University of Illinois Hospital at Chicago, Chicago, Illinois (S.M.T.).
  • Zhang J; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (J.Z.).
  • Mallappallil M; Kings County Hospital Center, New York City Health and Hospital Corporation, Brooklyn, New York (M.M.).
  • Redfern RE; ProMedica Research, ProMedica Toledo Hospital, Toledo, Ohio (R.E.R.).
  • Bansal AD; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.D.B.).
  • Short SAP; University of Vermont Larner College of Medicine, Burlington, Vermont (S.A.S.).
  • Vangel MG; Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts (M.G.V.).
  • Admon AJ; University of Michigan, Ann Arbor, Michigan (A.J.A.).
  • Semler MW; Vanderbilt University Medical Center, Nashville, Tennessee (M.W.S.).
  • Bauer KA; Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.A.B.).
  • Hernán MA; Harvard T.H. Chan School of Public Health and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts (M.A.H.).
  • Leaf DE; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.G., D.E.L.).
Ann Intern Med ; 174(5): 622-632, 2021 05.
Article in English | MEDLINE | ID: covidwho-1049179
ABSTRACT

BACKGROUND:

Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).

OBJECTIVE:

To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival.

DESIGN:

In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used.

SETTING:

67 hospitals in the United States.

PARTICIPANTS:

Adults with COVID-19 admitted to a participating ICU. MEASUREMENTS Time to death, censored at hospital discharge, or date of last follow-up.

RESULTS:

Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]).

LIMITATION:

Observational design.

CONCLUSION:

Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation. PRIMARY FUNDING SOURCE None.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Coagulation Disorders / COVID-19 / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Ann Intern Med Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Coagulation Disorders / COVID-19 / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Ann Intern Med Year: 2021 Document Type: Article