Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study
Background: Microthrombosis and large-vessel thrombosis are the main triggers of COVID-19 worsening. The optimal anticoagulant regimen in COVID-19 patients hospitalized in medical wards remains unknown.Objectives: To evaluate the effects of intermediate-dose vs. standard-dose prophylactic anticoagul...
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.747527/full |
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| author | David M. Smadja David M. Smadja David M. Smadja Guillaume Bonnet Guillaume Bonnet Nicolas Gendron Nicolas Gendron Orianne Weizman Orianne Weizman Lina Khider Antonin Trimaille Tristan Mirault Tristan Mirault Charles Fauvel Jean-Luc Diehl Jean-Luc Diehl Delphine Mika Aurelien Philippe Aurelien Philippe Théo Pezel Guillaume Goudot Guillaume Goudot Willy Sutter Willy Sutter Benjamin Planquette Benjamin Planquette Benjamin Planquette Victor Waldmann Victor Waldmann Olivier Sanchez Olivier Sanchez Olivier Sanchez Ariel Cohen Richard Chocron Richard Chocron |
| author_facet | David M. Smadja David M. Smadja David M. Smadja Guillaume Bonnet Guillaume Bonnet Nicolas Gendron Nicolas Gendron Orianne Weizman Orianne Weizman Lina Khider Antonin Trimaille Tristan Mirault Tristan Mirault Charles Fauvel Jean-Luc Diehl Jean-Luc Diehl Delphine Mika Aurelien Philippe Aurelien Philippe Théo Pezel Guillaume Goudot Guillaume Goudot Willy Sutter Willy Sutter Benjamin Planquette Benjamin Planquette Benjamin Planquette Victor Waldmann Victor Waldmann Olivier Sanchez Olivier Sanchez Olivier Sanchez Ariel Cohen Richard Chocron Richard Chocron |
| author_sort | David M. Smadja |
| collection | DOAJ |
| description | Background: Microthrombosis and large-vessel thrombosis are the main triggers of COVID-19 worsening. The optimal anticoagulant regimen in COVID-19 patients hospitalized in medical wards remains unknown.Objectives: To evaluate the effects of intermediate-dose vs. standard-dose prophylactic anticoagulation (AC) among patients with COVID-19 hospitalized in medical wards.Methods and results: We used a large French multicentric retrospective study enrolling 2,878 COVID-19 patients hospitalized in medical wards. After exclusion of patients who had an AC treatment before hospitalization, we generated a propensity-score-matched cohort of patients who were treated with intermediate-dose or standard-dose prophylactic AC between February 26 and April 20, 2020 (intermediate-dose, n = 261; standard-dose prophylactic anticoagulation, n = 763). The primary outcome of the study was in-hospital mortality; this occurred in 23 of 261 (8.8%) patients in the intermediate-dose group and 74 of 783 (9.4%) patients in the standard-dose prophylactic AC group (p = 0.85); while time to death was also the same in both the treatment groups (11.5 and 11.6 days, respectively, p = 0.17). We did not observe any difference regarding venous and arterial thrombotic events between the intermediate dose and standard dose, respectively (venous thrombotic events: 2.3 vs. 2.4%, p=0.99; arterial thrombotic events: 2.7 vs. 1.2%, p = 0.25). The 30-day Kaplan–Meier curves for in-hospital mortality demonstrate no statistically significant difference in in-hospital mortality (HR: 0.99 (0.63–1.60); p = 0.99). Moreover, we found that no particular subgroup was associated with a significant reduction in in-hospital mortality.Conclusion: Among COVID-19 patients hospitalized in medical wards, intermediate-dose prophylactic AC compared with standard-dose prophylactic AC did not result in a significant difference in in-hospital mortality. |
| first_indexed | 2024-12-19T15:32:54Z |
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| id | doaj.art-7e0945a04aa14b83b14c36e840f78537 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-19T15:32:54Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-7e0945a04aa14b83b14c36e840f785372022-12-21T20:15:40ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-10-01810.3389/fmed.2021.747527747527Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort StudyDavid M. Smadja0David M. Smadja1David M. Smadja2Guillaume Bonnet3Guillaume Bonnet4Nicolas Gendron5Nicolas Gendron6Orianne Weizman7Orianne Weizman8Lina Khider9Antonin Trimaille10Tristan Mirault11Tristan Mirault12Charles Fauvel13Jean-Luc Diehl14Jean-Luc Diehl15Delphine Mika16Aurelien Philippe17Aurelien Philippe18Théo Pezel19Guillaume Goudot20Guillaume Goudot21Willy Sutter22Willy Sutter23Benjamin Planquette24Benjamin Planquette25Benjamin Planquette26Victor Waldmann27Victor Waldmann28Olivier Sanchez29Olivier Sanchez30Olivier Sanchez31Ariel Cohen32Richard Chocron33Richard Chocron34Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, FranceDepartment of Hematology and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, FranceF-CRIN INNOVTE, Saint-Étienne, FranceParis Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, FranceCenter Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique Haut-Lévêque, Unité Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Pessac, FranceInnovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, FranceDepartment of Hematology and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, FranceParis Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, FranceInstitut Lorrain du Coeur et des Vaisseaux, CHU de Nancy, Vandoeuvre les Nancy, FranceDepartment of Vascular Medicine, AP-HP, Georges Pompidou European Hospital, Paris, FranceNouvel Hôpital Civil, Center Hospitalier Régional Universitaire de Strasbourg, Strasbourg, FranceParis Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, FranceDepartment of Vascular Medicine, AP-HP, Georges Pompidou European Hospital, Paris, FranceRouen University Hospital, FHU REMOD-VHF, Rouen, FranceInnovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France0Medical Intensive Care Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France1INSERM, Université Paris-Saclay, Chatenay-Malabry, FranceInnovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, FranceDepartment of Hematology and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France2Department of Cardiology, Lariboisière Hospital, AP-HP, University of Paris, Paris, FranceParis Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, FranceDepartment of Vascular Medicine, AP-HP, Georges Pompidou European Hospital, Paris, FranceParis Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France3Department of Vascular Surgery, AP-HP, Georges Pompidou European Hospital, Paris, FranceInnovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, FranceF-CRIN INNOVTE, Saint-Étienne, France4Department of Pneumology and Intensive Care and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, FranceParis Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France5Department of Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, FranceInnovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, FranceF-CRIN INNOVTE, Saint-Étienne, France4Department of Pneumology and Intensive Care and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France6Department of Cardiology, AP-HP, Saint Antoine Hospital, Paris, FranceParis Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France7Department of Emergency, AP-HP, Georges Pompidou European Hospital, Paris, FranceBackground: Microthrombosis and large-vessel thrombosis are the main triggers of COVID-19 worsening. The optimal anticoagulant regimen in COVID-19 patients hospitalized in medical wards remains unknown.Objectives: To evaluate the effects of intermediate-dose vs. standard-dose prophylactic anticoagulation (AC) among patients with COVID-19 hospitalized in medical wards.Methods and results: We used a large French multicentric retrospective study enrolling 2,878 COVID-19 patients hospitalized in medical wards. After exclusion of patients who had an AC treatment before hospitalization, we generated a propensity-score-matched cohort of patients who were treated with intermediate-dose or standard-dose prophylactic AC between February 26 and April 20, 2020 (intermediate-dose, n = 261; standard-dose prophylactic anticoagulation, n = 763). The primary outcome of the study was in-hospital mortality; this occurred in 23 of 261 (8.8%) patients in the intermediate-dose group and 74 of 783 (9.4%) patients in the standard-dose prophylactic AC group (p = 0.85); while time to death was also the same in both the treatment groups (11.5 and 11.6 days, respectively, p = 0.17). We did not observe any difference regarding venous and arterial thrombotic events between the intermediate dose and standard dose, respectively (venous thrombotic events: 2.3 vs. 2.4%, p=0.99; arterial thrombotic events: 2.7 vs. 1.2%, p = 0.25). The 30-day Kaplan–Meier curves for in-hospital mortality demonstrate no statistically significant difference in in-hospital mortality (HR: 0.99 (0.63–1.60); p = 0.99). Moreover, we found that no particular subgroup was associated with a significant reduction in in-hospital mortality.Conclusion: Among COVID-19 patients hospitalized in medical wards, intermediate-dose prophylactic AC compared with standard-dose prophylactic AC did not result in a significant difference in in-hospital mortality.https://www.frontiersin.org/articles/10.3389/fmed.2021.747527/fullSARS-CoV-2anticoagulationintermediate doseprophylactic treatmentmortalityCOVID-19 |
| spellingShingle | David M. Smadja David M. Smadja David M. Smadja Guillaume Bonnet Guillaume Bonnet Nicolas Gendron Nicolas Gendron Orianne Weizman Orianne Weizman Lina Khider Antonin Trimaille Tristan Mirault Tristan Mirault Charles Fauvel Jean-Luc Diehl Jean-Luc Diehl Delphine Mika Aurelien Philippe Aurelien Philippe Théo Pezel Guillaume Goudot Guillaume Goudot Willy Sutter Willy Sutter Benjamin Planquette Benjamin Planquette Benjamin Planquette Victor Waldmann Victor Waldmann Olivier Sanchez Olivier Sanchez Olivier Sanchez Ariel Cohen Richard Chocron Richard Chocron Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study Frontiers in Medicine SARS-CoV-2 anticoagulation intermediate dose prophylactic treatment mortality COVID-19 |
| title | Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study |
| title_full | Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study |
| title_fullStr | Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study |
| title_full_unstemmed | Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study |
| title_short | Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study |
| title_sort | intermediate vs standard dose prophylactic anticoagulation in patients with covid 19 admitted in medical ward a propensity score matched cohort study |
| topic | SARS-CoV-2 anticoagulation intermediate dose prophylactic treatment mortality COVID-19 |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.747527/full |
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