| Autor: |
Linda Nab, Chantal Visser, van Bas Bussel, Albertus Beishuizen, Remy Bemelmans, Hugo ten Cate, F. Croles, van Coen Guldener, de C. Jager, Menno Huisman, Marten Nijziel, Pieter Kamphuisen, Frederikus Klok, Stephanie Koster, Nuray Kuşadasi, Karina Meijer, Corstiaan Uil, Roger Schutgens, Frank Stam, Alexander Vlaar, Eline Vlot, Marijke Linschoten, Folkert Asselbergs, Marieke Kruip, le Saskia Cessie, Suzanne Cannegieter |
| Rok vydání: |
2023 |
| DOI: |
10.21203/rs.3.rs-2846151/v1 |
| Popis: |
Thrombotic complications are common in Coronavirus disease 2019 (COVID-19) patients, with pulmonary embolism (PE) being the most frequent. Randomised trials have provided inconclusive results on the optimal dosage of thromboprophylaxis in critically ill COVID-19 patients. We utilized data from the multicentre CAPACITY-COVID patient registry to assess the effect of differential application of Low Molecular Weight Heparin (LMWH) dose protocols on PE and in-hospital mortality risk in critically ill COVID-19 patients. An instrumental variable analysis was performed to estimate the intention-to-treat effect, utilizing differences in thromboprophylaxis prescribing behaviour between hospitals. We included 939 patients with PCR confirmed SARS-CoV-2 infection from 34 hospitals. Two-hundred-and-one patients (21%) developed a PE. The adjusted cause-specific HR of PE was 0.92 (95% CI: 0.73–1.16) per doubling of LMWH dose. The adjusted cause-specific HR for in-hospital mortality was 0.82 (95% CI: 0.65–1.02) per doubling of LMWH dose. This dose-response relationship was shown to be non-linear. To conclude, this study did not find evidence for an effect of LMWH dose on the risk of PE, but suggested a non-linear decreased risk of in-hospital mortality for higher doses of LMWH. However, uncertainty remains, and the dose-response relationship between LMWH dose and in-hospital mortality needs further investigation in well-designed studies. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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