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Real-World Management of Pharmacological Thromboprophylactic Strategies for COVID-19 Patients in Japan: From the CLOT-COVID Study.
Hayashi, Hiroya; Izumiya, Yasuhiro; Fukuda, Daiju; Wakita, Fumiaki; Mizobata, Yasumitsu; Fujii, Hiromichi; Yachi, Sen; Takeyama, Makoto; Nishimoto, Yuji; Tsujino, Ichizo; Nakamura, Junichi; Yamamoto, Naoto; Nakata, Hiroko; Ikeda, Satoshi; Umetsu, Michihisa; Aikawa, Shizu; Satokawa, Hirono; Okuno, Yoshinori; Iwata, Eriko; Ogihara, Yoshito; Ikeda, Nobutaka; Kondo, Akane; Iwai, Takehisa; Yamada, Norikazu; Ogawa, Tomohiro; Kobayashi, Takao; Mo, Makoto; Yamashita, Yugo.
  • Hayashi H; Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
  • Izumiya Y; Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
  • Fukuda D; Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
  • Wakita F; Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
  • Mizobata Y; Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
  • Fujii H; Department of Intensive Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
  • Yachi S; Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan.
  • Takeyama M; Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan.
  • Nishimoto Y; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
  • Tsujino I; Hokkaido University Hospital, Sapporo, Japan.
  • Nakamura J; Hokkaido University Hospital, Sapporo, Japan.
  • Yamamoto N; Hamamatsu Medical Center, Hamamatsu, Japan.
  • Nakata H; Yokosuka General Hospital Uwamachi, Yokosuka, Japan.
  • Ikeda S; Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
  • Umetsu M; Tohoku University Hospital, Sendai, Japan.
  • Aikawa S; Tsukuba Medical Center Hospital, Tsukuba, Japan.
  • Satokawa H; Fukushima Red Cross Hospital, Fukushima, Japan.
  • Okuno Y; Kyoto University Hospital, Kyoto, Japan.
  • Iwata E; Nankai Medical Center Japan Community Health Care Organization, Saiki, Japan.
  • Ogihara Y; Mie University Hospital, Tsu, Japan.
  • Ikeda N; Toho University Ohashi Medical Center, Tokyo, Japan.
  • Kondo A; Shikoku Medical Center for Children and Adults, Zentsuji, Japan.
  • Iwai T; Tsukuba Vascular Center, Ibaraki, Japan.
  • Yamada N; Kuwana City Medical Center, Kuwana, Japan.
  • Ogawa T; Fukushima Daiich Hospital, Fukushima, Japan.
  • Kobayashi T; Hamamatsu Medical Center, Hamamatsu, Japan.
  • Mo M; Yokohama Minami Kyosai Hospital, Yokohama, Japan.
  • Yamashita Y; Kyoto University Hospital, Kyoto, Japan.
JACC Asia ; 2(7): 897-907, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2179892
ABSTRACT

Background:

Data on prophylactic anticoagulation are important in understanding the current issues, unmet needs, and optimal management of Japanese COVID-19 patients.

Objectives:

This study aimed to investigate the clinical management strategies for prophylactic anticoagulation of COVID-19 patients in Japan.

Methods:

The CLOT-COVID study was a multicenter observational study that enrolled 2,894 consecutive hospitalized patients with COVID-19. The study population consisted of 2,889 patients (after excluding 5 patients with missing data); it was divided into 2 groups patients with pharmacological thromboprophylaxis (n = 1,240) and those without (n = 1,649). Furthermore, we evaluated the 1,233 patients who received prophylactic anticoagulation-excluding 7 patients who could not be classified based on the intensity of their anticoagulants-who were then divided into 2 groups patients receiving prophylactic anticoagulant doses (n = 889) and therapeutic anticoagulant doses (n = 344).

Results:

The most common pharmacological thromboprophylaxis anticoagulant was unfractionated heparin (68.2%). The severity of COVID-19 at admission was a predictor of the implementation of pharmacological thromboprophylaxis in the multivariable analysis (moderate vs mild OR 16.6; 95% CI13.2-21.0; P < 0.001, severe vs mild OR 342.6, 95% CI 107.7-1090.2; P < 0.001). It was also a predictor of the usage of anticoagulants of therapeutic doses in the multivariable analysis (moderate vs mild OR 2.10; 95% CI 1.46-3.02; P < 0.001, severe vs mild OR 5.96; 95% CI 3.91-9.09; P < 0.001).

Conclusions:

In the current real-world Japanese registry, pharmacological thromboprophylaxis, especially anticoagulants at therapeutic doses, was selectively implemented in COVID-19 patients with comorbidities and severe COVID-19 status at admission.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: JACC Asia Year: 2022 Document Type: Article Affiliation country: J.jacasi.2022.09.005

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: JACC Asia Year: 2022 Document Type: Article Affiliation country: J.jacasi.2022.09.005