Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study
Abstract Background Thromboprophylaxis of COVID-19 patients is a highly debated issue. We aimed to compare the occurrence of thrombotic/ischemic events in COVID-19 patients with acute respiratory distress syndrome (ARDS) treated with either prophylactic or therapeutic dosage of heparin. All patients...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-01-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-021-00809-5 |
| _version_ | 1819169008691183616 |
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| author | Julie Helms François Severac Hamid Merdji Maleka Schenck Raphaël Clere-Jehl Mathieu Baldacini Mickaël Ohana Lélia Grunebaum Vincent Castelain Eduardo Anglés-Cano Laurent Sattler Ferhat Meziani for the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care Sepsis Trial Group for Global EvaluationResearch in Sepsis) |
| author_facet | Julie Helms François Severac Hamid Merdji Maleka Schenck Raphaël Clere-Jehl Mathieu Baldacini Mickaël Ohana Lélia Grunebaum Vincent Castelain Eduardo Anglés-Cano Laurent Sattler Ferhat Meziani for the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care Sepsis Trial Group for Global EvaluationResearch in Sepsis) |
| author_sort | Julie Helms |
| collection | DOAJ |
| description | Abstract Background Thromboprophylaxis of COVID-19 patients is a highly debated issue. We aimed to compare the occurrence of thrombotic/ischemic events in COVID-19 patients with acute respiratory distress syndrome (ARDS) treated with either prophylactic or therapeutic dosage of heparin. All patients referred for COVID-19 ARDS in two intensive care units (ICUs) from two centers of a French tertiary hospital were included in our cohort study. Patients were compared according to their anticoagulant treatment to evaluate the risk/benefit of prophylactic anticoagulation versus therapeutic anticoagulation. Medical history, symptoms, biological data and imaging were prospectively collected. Results One hundred and seventy-nine patients (73% men) were analyzed: 108 in prophylactic group and 71 in therapeutic group. Median age and SAPS II were 62 [IQR 51; 70] years and 47 [IQR 37; 63] points. ICU mortality rate was 17.3%. Fifty-seven patients developed clinically relevant thrombotic complications during their ICU stay, less frequently in therapeutic group (adjusted OR 0.38 [0.14–0.94], p = 0.04). The occurrences of pulmonary embolism (PE), deep vein thrombosis (DVT) and ischemic stroke were significantly lower in the therapeutic group (respective adjusted OR for PE: 0.19 [0.03–0.81]; DVT: 0.13 [0.01–0.89], stroke: 0.06 [0–0.68], all p < 0.05). The occurrence of bleeding complications was not significantly different between groups, neither were ICU length of stay or mortality rate. D-dimer levels were significantly lower during ICU stay, and aPTT ratio was more prolonged in the therapeutic group (p < 0.05). Conclusion Increasing the anticoagulation of severe COVID-19 patients to a therapeutic level might decrease thrombotic complications without increasing their bleeding risk. |
| first_indexed | 2024-12-22T19:12:40Z |
| format | Article |
| id | doaj.art-52e7b46a035d44568841f496a1d2401e |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-22T19:12:40Z |
| publishDate | 2021-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-52e7b46a035d44568841f496a1d2401e2022-12-21T18:15:36ZengSpringerOpenAnnals of Intensive Care2110-58202021-01-011111810.1186/s13613-021-00809-5Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort studyJulie Helms0François Severac1Hamid Merdji2Maleka Schenck3Raphaël Clere-Jehl4Mathieu Baldacini5Mickaël Ohana6Lélia Grunebaum7Vincent Castelain8Eduardo Anglés-Cano9Laurent Sattler10Ferhat Meziani11for the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care Sepsis Trial Group for Global EvaluationResearch in Sepsis)Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de StrasbourgGroupe Méthodes en Recherche Clinique (GMRC), Hôpital Civil, Hôpitaux Universitaires de StrasbourgService de Médecine Intensive Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de StrasbourgService de Médecine Intensive Réanimation, Hôpitaux Universitaires de StrasbourgService de Médecine Intensive Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de StrasbourgService de Médecine Intensive Réanimation, Hôpitaux Universitaires de StrasbourgRadiology Department, Nouvel Hôpital Civil, Strasbourg University HospitalLaboratoire d’Hématologie, Hôpitaux Universitaires de StrasbourgLaboratoire d’Hématologie, Hôpitaux Universitaires de StrasbourgInnovative Therapies in Haemostasis, INSERM UMR_S 1140, Université de ParisLaboratoire d’Hématologie, Hôpitaux Universitaires de StrasbourgService de Médecine Intensive Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de StrasbourgAbstract Background Thromboprophylaxis of COVID-19 patients is a highly debated issue. We aimed to compare the occurrence of thrombotic/ischemic events in COVID-19 patients with acute respiratory distress syndrome (ARDS) treated with either prophylactic or therapeutic dosage of heparin. All patients referred for COVID-19 ARDS in two intensive care units (ICUs) from two centers of a French tertiary hospital were included in our cohort study. Patients were compared according to their anticoagulant treatment to evaluate the risk/benefit of prophylactic anticoagulation versus therapeutic anticoagulation. Medical history, symptoms, biological data and imaging were prospectively collected. Results One hundred and seventy-nine patients (73% men) were analyzed: 108 in prophylactic group and 71 in therapeutic group. Median age and SAPS II were 62 [IQR 51; 70] years and 47 [IQR 37; 63] points. ICU mortality rate was 17.3%. Fifty-seven patients developed clinically relevant thrombotic complications during their ICU stay, less frequently in therapeutic group (adjusted OR 0.38 [0.14–0.94], p = 0.04). The occurrences of pulmonary embolism (PE), deep vein thrombosis (DVT) and ischemic stroke were significantly lower in the therapeutic group (respective adjusted OR for PE: 0.19 [0.03–0.81]; DVT: 0.13 [0.01–0.89], stroke: 0.06 [0–0.68], all p < 0.05). The occurrence of bleeding complications was not significantly different between groups, neither were ICU length of stay or mortality rate. D-dimer levels were significantly lower during ICU stay, and aPTT ratio was more prolonged in the therapeutic group (p < 0.05). Conclusion Increasing the anticoagulation of severe COVID-19 patients to a therapeutic level might decrease thrombotic complications without increasing their bleeding risk.https://doi.org/10.1186/s13613-021-00809-5AnticoagulationCoagulopathyCOVID-19Pulmonary embolismSARS-CoV-2Thrombosis |
| spellingShingle | Julie Helms François Severac Hamid Merdji Maleka Schenck Raphaël Clere-Jehl Mathieu Baldacini Mickaël Ohana Lélia Grunebaum Vincent Castelain Eduardo Anglés-Cano Laurent Sattler Ferhat Meziani for the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care Sepsis Trial Group for Global EvaluationResearch in Sepsis) Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study Annals of Intensive Care Anticoagulation Coagulopathy COVID-19 Pulmonary embolism SARS-CoV-2 Thrombosis |
| title | Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study |
| title_full | Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study |
| title_fullStr | Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study |
| title_full_unstemmed | Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study |
| title_short | Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study |
| title_sort | higher anticoagulation targets and risk of thrombotic events in severe covid 19 patients bi center cohort study |
| topic | Anticoagulation Coagulopathy COVID-19 Pulmonary embolism SARS-CoV-2 Thrombosis |
| url | https://doi.org/10.1186/s13613-021-00809-5 |
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