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D-Dimer-Driven Anticoagulation Reduces Mortality in Intubated COVID-19 Patients: A Cohort Study With a Propensity-Matched Analysis.
Tassiopoulos, Apostolos K; Mofakham, Sima; Rubano, Jerry A; Labropoulos, Nicos; Bannazadeh, Mohsen; Drakos, Panagiotis; Volteas, Panagiotis; Cleri, Nathaniel A; Alkadaa, Leor N; Asencio, Anthony A; Oganov, Anthony; Hou, Wei; Rutigliano, Daniel N; Singer, Adam J; Vosswinkel, James; Talamini, Mark; Mikell, Charles B; Kaushansky, Kenneth.
  • Tassiopoulos AK; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Mofakham S; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Rubano JA; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Labropoulos N; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Bannazadeh M; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Drakos P; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Volteas P; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Cleri NA; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Alkadaa LN; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Asencio AA; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Oganov A; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Hou W; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Rutigliano DN; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Singer AJ; Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Vosswinkel J; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Talamini M; Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Mikell CB; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
  • Kaushansky K; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.
Front Med (Lausanne) ; 8: 631335, 2021.
Article in English | MEDLINE | ID: covidwho-1106032
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Negative Regulation of Coagulation PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
PROCESS_OF
Object
Patients
3. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
4. Negative Regulation of Coagulation AFFECTS Complication
Subject
Negative Regulation of Coagulation
Predicate
AFFECTS
Object
Complication
5. Serum LOCATION_OF creatinine
Subject
Serum
Predicate
LOCATION_OF
Object
creatinine
6. Abnormal renal function PROCESS_OF Patients
Subject
Abnormal renal function
Predicate
PROCESS_OF
Object
Patients
7. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
8. Severe infection PROCESS_OF Patients
Subject
Severe infection
Predicate
PROCESS_OF
Object
Patients
9. Thrombophilia CAUSES Complication
Subject
Thrombophilia
Predicate
CAUSES
Object
Complication
10. Thrombophilia CAUSES Single organ dysfunction
Subject
Thrombophilia
Predicate
CAUSES
Object
Single organ dysfunction
11. Single organ dysfunction PROCESS_OF Patients
Subject
Single organ dysfunction
Predicate
PROCESS_OF
Object
Patients
12. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
13. Negative Regulation of Coagulation PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
PROCESS_OF
Object
Patients
14. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
15. Negative Regulation of Coagulation AFFECTS Complication
Subject
Negative Regulation of Coagulation
Predicate
AFFECTS
Object
Complication
16. Serum LOCATION_OF creatinine
Subject
Serum
Predicate
LOCATION_OF
Object
creatinine
17. Abnormal renal function PROCESS_OF Patients
Subject
Abnormal renal function
Predicate
PROCESS_OF
Object
Patients
18. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
19. Severe infection PROCESS_OF Patients
Subject
Severe infection
Predicate
PROCESS_OF
Object
Patients
20. Thrombophilia CAUSES Complication
Subject
Thrombophilia
Predicate
CAUSES
Object
Complication
21. Thrombophilia CAUSES Single organ dysfunction
Subject
Thrombophilia
Predicate
CAUSES
Object
Single organ dysfunction
22. Single organ dysfunction PROCESS_OF Patients
Subject
Single organ dysfunction
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

Objective:

Examine the possible beneficial effects of early, D-dimer driven anticoagulation in preventing thrombotic complications and improving the overall outcomes of COVID-19 intubated patients.

Methods:

To address COVID-19 hypercoagulability, we developed a clinical protocol to escalate anticoagulation based on serum D-dimer levels. We retrospectively reviewed all our first 240 intubated patients with COVID-19. Of the 240, 195 were stratified into patients treated based on this protocol (ON-protocol, n = 91) and the control group, patients who received standard thromboprophylaxis (OFF-protocol, n = 104). All patients were admitted to the Stony Brook University Hospital intensive care units (ICUs) between February 7th, 2020 and May 17, 2020 and were otherwise treated in the same manner for all aspects of COVID-19 disease.

Results:

We found that the overall mortality was significantly lower ON-protocol compared to OFF-protocol (27.47 vs. 58.66%, P < 0.001). Average maximum D-dimer levels were significantly lower in the ON-protocol group (7,553 vs. 12,343 ng/mL), as was serum creatinine (2.2 vs. 2.8 mg/dL). Patients with poorly controlled D-dimer levels had higher rates of kidney dysfunction and mortality. Transfusion requirements and serious bleeding events were similar between groups. To address any possible between-group differences, we performed a propensity-matched analysis of 124 of the subjects (62 matched pairs, ON-protocol and OFF-protocol), which showed similar findings (31 vs. 57% overall mortality in the ON-protocol and OFF-protocol group, respectively).

Conclusions:

D-dimer-driven anticoagulation appears to be safe in patients with COVID-19 infection and is associated with improved survival. What This Paper Adds It has been shown that hypercoagulability in patients with severe COVID-19 infection leads to thromboembolic complications and organ dysfunction. Anticoagulation has been variably administered to these patients, but it is unknown whether routine or escalated thromboprophylaxis provides a survival benefit. Our data shows that escalated D-dimer driven anticoagulation is associated with improved organ function and overall survival in intubated COVID-19 ICU patients at our institution. Importantly, we found that timely escalation of this anticoagulation is critical in preventing organ dysfunction and mortality in patients with severe COVID-19 infection.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Clinical Practice Guide / Observational study / Randomized controlled trials / Risk factors Language: English Journal: Front Med (Lausanne) Year: 2021 Document Type: Article Affiliation country: Fmed.2021.631335

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Clinical Practice Guide / Observational study / Randomized controlled trials / Risk factors Language: English Journal: Front Med (Lausanne) Year: 2021 Document Type: Article Affiliation country: Fmed.2021.631335