D-Dimer-Driven Anticoagulation Reduces Mortality in Intubated COVID-19 Patients: A Cohort Study With a Propensity-Matched Analysis.

Autor:	Tassiopoulos AK; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Mofakham S; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States., Rubano JA; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Labropoulos N; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Bannazadeh M; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States.; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Drakos P; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Volteas P; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Cleri NA; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States., Alkadaa LN; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States., Asencio AA; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States., Oganov A; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States., Hou W; Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, United States., Rutigliano DN; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Singer AJ; Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook, NY, United States., Vosswinkel J; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Talamini M; Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, United States., Mikell CB; Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, United States., Kaushansky K; Department of Medicine, Renaissance School of Medicine, Stony Brook, NY, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in medicine [Front Med (Lausanne)] 2021 Feb 04; Vol. 8, pp. 631335. Date of Electronic Publication: 2021 Feb 04 (Print Publication: 2021).
DOI:	10.3389/fmed.2021.631335
Abstrakt:	Objective: Examine the possible beneficial effects of early, D-dimer driven anticoagulation in preventing thrombotic complications and improving the overall outcomes of COVID-19 intubated patients. Methods: To address COVID-19 hypercoagulability, we developed a clinical protocol to escalate anticoagulation based on serum D-dimer levels. We retrospectively reviewed all our first 240 intubated patients with COVID-19. Of the 240, 195 were stratified into patients treated based on this protocol (ON-protocol, n = 91) and the control group, patients who received standard thromboprophylaxis (OFF-protocol, n = 104). All patients were admitted to the Stony Brook University Hospital intensive care units (ICUs) between February 7th, 2020 and May 17, 2020 and were otherwise treated in the same manner for all aspects of COVID-19 disease. Results: We found that the overall mortality was significantly lower ON-protocol compared to OFF-protocol (27.47 vs. 58.66%, P < 0.001). Average maximum D-dimer levels were significantly lower in the ON-protocol group (7,553 vs. 12,343 ng/mL), as was serum creatinine (2.2 vs. 2.8 mg/dL). Patients with poorly controlled D-dimer levels had higher rates of kidney dysfunction and mortality. Transfusion requirements and serious bleeding events were similar between groups. To address any possible between-group differences, we performed a propensity-matched analysis of 124 of the subjects (62 matched pairs, ON-protocol and OFF-protocol), which showed similar findings (31 vs. 57% overall mortality in the ON-protocol and OFF-protocol group, respectively). Conclusions: D-dimer-driven anticoagulation appears to be safe in patients with COVID-19 infection and is associated with improved survival. What This Paper Adds: It has been shown that hypercoagulability in patients with severe COVID-19 infection leads to thromboembolic complications and organ dysfunction. Anticoagulation has been variably administered to these patients, but it is unknown whether routine or escalated thromboprophylaxis provides a survival benefit. Our data shows that escalated D-dimer driven anticoagulation is associated with improved organ function and overall survival in intubated COVID-19 ICU patients at our institution. Importantly, we found that timely escalation of this anticoagulation is critical in preventing organ dysfunction and mortality in patients with severe COVID-19 infection. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Tassiopoulos, Mofakham, Rubano, Labropoulos, Bannazadeh, Drakos, Volteas, Cleri, Alkadaa, Asencio, Oganov, Hou, Rutigliano, Singer, Vosswinkel, Talamini, Mikell and Kaushansky.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu