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Safety profile of enhanced thromboprophylaxis strategies for critically ill COVID-19 patients during the first wave of the pandemic: observational report from 28 European intensive care units.
Lavinio, Andrea; Ercole, Ari; Battaglini, Denise; Magnoni, Sandra; Badenes, Rafael; Taccone, Fabio Silvio; Helbok, Raimund; Thomas, William; Pelosi, Paolo; Robba, Chiara.
  • Lavinio A; Neurosciences and Trauma Critical Care Unit, Addenbrookes Hospital Cambridge, Cambridge, UK.
  • Ercole A; Neurosciences and Trauma Critical Care Unit, Addenbrookes Hospital Cambridge, Cambridge, UK.
  • Battaglini D; San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
  • Magnoni S; Anestesia e Rianimazione Ospedale Santa Chiara, APSS, Trento, Italy.
  • Badenes R; Department of Anesthesia and Intensive Care, Hospital Clinic Universitari, University of Valencia, INCLIVA Research Health Institute, Valencia, Spain. rafaelbadenes@gmail.com.
  • Taccone FS; Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
  • Helbok R; Department of Neurology, Neurocritical Care Unit, Medical University of Innsbruck, Innsbruck, Austria.
  • Thomas W; Hematology Department, Addenbrookes Hospital, Cambridge, UK.
  • Pelosi P; San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
  • Robba C; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy.
Crit Care ; 25(1): 155, 2021 04 22.
Article in English | MEDLINE | ID: covidwho-1199922
ABSTRACT

INTRODUCTION:

Critical illness from SARS-CoV-2 infection (COVID-19) is associated with a high burden of pulmonary embolism (PE) and thromboembolic events despite standard thromboprophylaxis. Available guidance is discordant, ranging from standard care to the use of therapeutic anticoagulation for enhanced thromboprophylaxis (ET). Local ET protocols have been empirically determined and are generally intermediate between standard prophylaxis and full anticoagulation. Concerns have been raised in regard to the potential risk of haemorrhage associated with therapeutic anticoagulation. This report describes the prevalence and safety of ET strategies in European Intensive Care Unit (ICUs) and their association with outcomes during the first wave of the COVID pandemic, with particular focus on haemorrhagic complications and ICU mortality.

METHODS:

Retrospective, observational, multi-centre study including adult critically ill COVID-19 patients. Anonymised data included demographics, clinical characteristics, thromboprophylaxis and/or anticoagulation treatment. Critical haemorrhage was defined as intracranial haemorrhage or bleeding requiring red blood cells transfusion. Survival was collected at ICU discharge. A multivariable mixed effects generalised linear model analysis matched for the propensity for receiving ET was constructed for both ICU mortality and critical haemorrhage.

RESULTS:

A total of 852 (79% male, age 66 [37-85] years) patients were included from 28 ICUs. Median body mass index and ICU length of stay were 27.7 (25.1-30.7) Kg/m2 and 13 (7-22) days, respectively. Thromboembolic events were reported in 146 patients (17.1%), of those 78 (9.2%) were PE. ICU mortality occurred in 335/852 (39.3%) patients. ET was used in 274 (32.1%) patients, and it was independently associated with significant reduction in ICU mortality (log odds = 0.64 [95% CIs 0.18-1.1; p = 0.0069]) but not an increased risk of critical haemorrhage (log odds = 0.187 [95%CI - 0.591 to - 0.964; p = 0.64]).

CONCLUSIONS:

In a cohort of critically ill patients with a high prevalence of thromboembolic events, ET was associated with reduced ICU mortality without an increased burden of haemorrhagic complications. This study suggests ET strategies are safe and associated with favourable outcomes. Whilst full anticoagulation has been questioned for prophylaxis in these patients, our results suggest that there may nevertheless be a role for enhanced / intermediate levels of prophylaxis. Clinical trials investigating causal relationship between intermediate thromboprophylaxis and clinical outcomes are urgently needed.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Care / Venous Thromboembolism / Pandemics / COVID-19 Drug Treatment / Anticoagulants Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03543-3

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Care / Venous Thromboembolism / Pandemics / COVID-19 Drug Treatment / Anticoagulants Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03543-3