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Impact of High-Dose Prophylactic Anticoagulation in Critically Ill Patients With COVID-19 Pneumonia.
Tacquard, Charles; Mansour, Alexandre; Godon, Alexandre; Godet, Julien; Poissy, Julien; Garrigue, Delphine; Kipnis, Eric; Rym Hamada, Sophie; Mertes, Paul Michel; Steib, Annick; Ulliel-Roche, Mathilde; Bouhemad, Bélaïd; 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.
  • Tacquard C; Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Mansour A; Department of Anesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, Rennes, France.
  • Godon A; Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France.
  • Godet J; Groupe Méthodes en Recherche Clinique, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Poissy J; University of Lille, Inserm U1285, CHU Lille, Pôle de Réanimation, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France.
  • Garrigue D; Department of Anesthesiology and Critical Care, Surgical Critical Care, Centre Hospitalier Universitaire Lille, Lille, France.
  • Kipnis E; University of Lille, CNRS, Inserm, CHU Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France.
  • Rym Hamada S; Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France.
  • Mertes PM; Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Steib A; Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Ulliel-Roche M; Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France.
  • Bouhemad B; Department of Anesthesiology and Intensive Care, Dijon University Hospital and University of Burgundy, Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, Dijon, France.
  • Nguyen M; Department of Anesthesiology and Intensive Care, Dijon University Hospital and University of Burgundy, Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, Dijon, France.
  • Reizine F; Service des Maladies Infectieuses et Réanimation Médicale, Rennes University Hospital, Rennes, France.
  • Gouin-Thibault I; Department of Hematology-Hemostasis, Rennes University Hospital, Rennes, France.
  • Besse MC; Service de Médecine Intensive-Réanimation, CHU de Tours, Tours, France.
  • Collercandy N; Service de Médecine Intensive-Réanimation, CHU de Tours, Tours, France.
  • Mankikian S; Service de Médecine Intensive-Réanimation, CHU de Tours, Tours, France.
  • Levy JH; Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC.
  • Gruel Y; Department of Hematology-Hemostasis, Tours University Hospital, Tours, France.
  • Albaladejo P; Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France.
  • Susen S; Hemostasis Department, Heart and Lung Institute, CHU Lille, Lille, France. Electronic address: sophiesusen@aol.com.
  • Godier A; Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France.
Chest ; 159(6): 2417-2427, 2021 06.
Article in English | MEDLINE | ID: covidwho-1131172
ABSTRACT

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. TRIAL REGISTRY ClinicalTrials.gov; No. NCT04405869; URL www.clinicaltrials.gov.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Critical Care / COVID-19 / Anticoagulants Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Chest Year: 2021 Document Type: Article Affiliation country: J.chest.2021.01.017

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Critical Care / COVID-19 / Anticoagulants Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Chest Year: 2021 Document Type: Article Affiliation country: J.chest.2021.01.017