Incidence of Venous Thromboembolism and Effect of Anticoagulant Dosing in Hospitalized COVID-19 Patients.

Autor:	Kumar G; Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, GA 30501, USA., Patel D; Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, GA 30501, USA., Odeh T; Department of Internal Medicine, Northeast Georgia Health System, Gainesville, GA 30501, USA., Rojas E; Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, GA 30501, USA., Sakhuja A; Division of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic Surgery, West Virginia University, WV 26506, USA., Meersman M; IPC Global, 4080 McGinnis Ferry Road, Building 100, Suite 103, Alpharetta, GA 30005, USA., Dalton D; IPC Global, 4080 McGinnis Ferry Road, Building 100, Suite 103, Alpharetta, GA 30005, USA., Nanchal R; Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI 53226, USA., Guddati AK; Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30909, USA.
Jazyk:	angličtina
Zdroj:	Journal of hematology [J Hematol] 2021 Aug; Vol. 10 (4), pp. 162-170. Date of Electronic Publication: 2021 Jul 28.
DOI:	10.14740/jh836
Abstrakt:	Background: Coronavirus disease 2019 (COVID-19) is characterized by coagulopathy and thrombotic events. We examined factors associated with development of venous thromboembolism (VTE) in COVID-19 and to discern if higher dose of anticoagulation was beneficial in these patients. Methods: This study involves an observational study of prospectively collected data in the setting of a large community hospital in a rural setting in Northeast Georgia with COVID-19 between March 1, 2020 and February 5, 2021. Anticoagulation dose (none, standard, intermediate, and therapeutic dosages) was studied in adult patients (≥ 18 years). We constructed multivariable logistic regression model to examine the association of clinical characteristics with VTE. To examine the effect of dose of anticoagulation in preventing VTE, we used inverse probability weighted regression adjustment. Results: Of the 4,645 patients with COVID-19, 251 (5.4%) patients were found to have VTE. Of these, 91 had pulmonary embolism, 148 had deep venous thrombosis (DVT) and 12 had both. A total of 129 of VTE cases were diagnosed at admission. Of all admissions, 12.9% did not receive any DVT prophylaxis, 70.4% received prophylactic dose, 1.3% received intermediate dose and 15.5% received therapeutic dose. Male gender (odds ratio (OR): 1.55, 95% confidence interval (CI): 1.0 - 2.4, P = 0.04) and Black race (OR: 2.0, 95% CI: 1.2 - 3.4, P = 0.01), along with higher levels of lactate dehydrogenase (LDH) and D-dimer were associated with higher odds of developing VTE. Patients receiving steroids had lower rates of VTE (3.9% vs. 8.3%, P < 0.001). Use of intermediate or therapeutic anticoagulation was not associated with lower odds of developing VTE. However, patients on therapeutic anticoagulation had lower odds of in hospital mortality when compared to standard dose (OR: 0.47, 95% CI: 0.27 - 0.80, P = 0.006). Conclusions: In COVID-19, D-dimer and LDH can be useful in predicting VTE. Steroids appear to have some protective role in development of VTE. Therapeutic anticoagulation did not result in lower rates of VTE but was associated with in-hospital mortality. Competing Interests: None to declare. (Copyright 2021, Kumar et al.)
Databáze:	MEDLINE
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