tetano
Editor, Senior Moderator
Crit Care Explor
. 2020 Dec 16;2(12):e0309.
doi: 10.1097/CCE.0000000000000309. eCollection 2020 Dec.
Clinical Outcomes With the Use of Prophylactic Versus Therapeutic Anticoagulation in Coronavirus Disease 2019
Jishu Kaul Motta[SUP] 1 [/SUP], Rahila O Ogunnaike[SUP] 1 [/SUP], Rutvik Shah[SUP] 1 [/SUP], Stephanie Stroever[SUP] 2 3 [/SUP], Harold V Cede?o[SUP] 1 [/SUP], Shyam K Thapa[SUP] 1 [/SUP], John J Chronakos[SUP] 4 5 [/SUP], Eric J Jimenez[SUP] 4 5 [/SUP], Joann Petrini[SUP] 2 6 [/SUP], Abhijith Hegde[SUP] 4 5 [/SUP]
Affiliations
Abstract
Objectives: To determine the impact of anticoagulation on inhospital mortality among coronavirus disease 2019-positive patients with the a priori hypothesis that there would be a lower risk of inhospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin.
Design setting: Retrospective cohort study from April 1, 2020, to April 25, 2020. The date of final follow-up was June 12, 2020 Two large, acute-care hospitals in Western Connecticut.
Patients: Five hundred and one inpatients were identified after discharge as 18 years or older and positive for severe acute respiratory syndrome coronavirus 2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, whereas the clinical variables were abstracted from patients' medical records.
Exposure: Preemptive enoxaparin or heparin at a therapeutic or prophylactic dose.
Main results: When comparing treatments through multivariable analysis, risk of inhospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0-4.9; p = 0.04). Additionally, the average treatment effects were higher (β = 0.11, p = 0.01) in the therapeutic group.
Conclusions: An increase in inhospital mortality was observed among patients on preemptive therapeutic anticoagulation. Thus, in the management of coronavirus disease 2019 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.
Keywords: anticoagulants; coronavirus; length of stay; mortality; pneumonia; thrombosis.
. 2020 Dec 16;2(12):e0309.
doi: 10.1097/CCE.0000000000000309. eCollection 2020 Dec.
Clinical Outcomes With the Use of Prophylactic Versus Therapeutic Anticoagulation in Coronavirus Disease 2019
Jishu Kaul Motta[SUP] 1 [/SUP], Rahila O Ogunnaike[SUP] 1 [/SUP], Rutvik Shah[SUP] 1 [/SUP], Stephanie Stroever[SUP] 2 3 [/SUP], Harold V Cede?o[SUP] 1 [/SUP], Shyam K Thapa[SUP] 1 [/SUP], John J Chronakos[SUP] 4 5 [/SUP], Eric J Jimenez[SUP] 4 5 [/SUP], Joann Petrini[SUP] 2 6 [/SUP], Abhijith Hegde[SUP] 4 5 [/SUP]
Affiliations
- PMID: 33354679
- PMCID: PMC7746209
- DOI: 10.1097/CCE.0000000000000309
Abstract
Objectives: To determine the impact of anticoagulation on inhospital mortality among coronavirus disease 2019-positive patients with the a priori hypothesis that there would be a lower risk of inhospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin.
Design setting: Retrospective cohort study from April 1, 2020, to April 25, 2020. The date of final follow-up was June 12, 2020 Two large, acute-care hospitals in Western Connecticut.
Patients: Five hundred and one inpatients were identified after discharge as 18 years or older and positive for severe acute respiratory syndrome coronavirus 2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, whereas the clinical variables were abstracted from patients' medical records.
Exposure: Preemptive enoxaparin or heparin at a therapeutic or prophylactic dose.
Main results: When comparing treatments through multivariable analysis, risk of inhospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0-4.9; p = 0.04). Additionally, the average treatment effects were higher (β = 0.11, p = 0.01) in the therapeutic group.
Conclusions: An increase in inhospital mortality was observed among patients on preemptive therapeutic anticoagulation. Thus, in the management of coronavirus disease 2019 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.
Keywords: anticoagulants; coronavirus; length of stay; mortality; pneumonia; thrombosis.