Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients.
Autor: | Gabara C; Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Solarat B; Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Castro P; Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain; Medical Intensive Care Unit, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Fernández S; Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain; Medical Intensive Care Unit, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Badia JR; Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Toapanta D; Liver ICU, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Schulman S; Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Reverter JC; Hematology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Soriano A; Infectious Disease Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain., Moisés J; Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain. Electronic address: jrmoises@clinic.cat., Aibar J; Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain. |
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Jazyk: | English; Spanish; Castilian |
Zdroj: | Medicina intensiva [Med Intensiva (Engl Ed)] 2021 Jul 30. Date of Electronic Publication: 2021 Jul 30. |
DOI: | 10.1016/j.medin.2021.07.004 |
Abstrakt: | Objective: To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients. Design: Retrospective observational and analytical cohort study. Setting: COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020. Patients: 201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic. Interventions: The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen. Main Variables of Interest: VTE, bleeding and mortality. Results: 78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p<0.001 and p<0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26-4.58, p=0.008) but had no impact on VTE. Conclusions: Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients. (Crown Copyright © 2021. Publicado por Elsevier España, S.L.U. All rights reserved.) |
Databáze: | MEDLINE |
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