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Anticoagulation Strategies in Critically Ill Patients With SARS-CoV-2 Infection: The Role of Direct Thrombin Inhibitors.
Pieri, Marina; Quaggiotti, Luisa; Fominskiy, Evgeny; Landoni, Giovanni; Calabrò, Maria Grazia; Ajello, Silvia; Bonizzoni, Matteo Aldo; Belletti, Alessandro; Scandroglio, Anna Mara.
  • Pieri M; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Quaggiotti L; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Fominskiy E; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Landoni G; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Calabrò MG; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Ajello S; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Bonizzoni MA; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Belletti A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Scandroglio AM; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: scandroglio.mara@hsr.it.
J Cardiothorac Vasc Anesth ; 36(8 Pt B): 2961-2967, 2022 08.
Article in English | MEDLINE | ID: covidwho-1795642
ABSTRACT

OBJECTIVES:

To compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

DESIGN:

An observational study.

SETTING:

At the intensive care unit of a university hospital. PARTICIPANTS AND

INTERVENTIONS:

Critically ill patients with a SARS-CoV-2 infection receiving full anticoagulation with heparin or bivalirudin. MEASUREMENTS AND MAIN

RESULTS:

Twenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group having higher mortality risk scores (SAPS II 60 ± 16 v 39 ±7, p < 0.001) and a higher need for extracorporeal support compared to the heparin group, hospital mortality was comparable (57% v 45, p = 0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% v 40%, p = 0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation; in addition to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in the bleeding rate was observed (65% v 35%, p = 0.08).

CONCLUSIONS:

Although heparin is the most used anticoagulant in the intensive care setting, bivalirudin-based anticoagulation was safe and effective in a cohort of critically ill patients with SARS-CoV-2. Bivalirudin may be given full consideration as an anticoagulation strategy for critically ill patients with SARS-CoV-2, especially in those with thrombocytopenia and on extracorporeal support.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: J Cardiothorac Vasc Anesth Journal subject: Anesthesiology / Cardiology Year: 2022 Document Type: Article Affiliation country: J.jvca.2022.03.004

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: J Cardiothorac Vasc Anesth Journal subject: Anesthesiology / Cardiology Year: 2022 Document Type: Article Affiliation country: J.jvca.2022.03.004