Prophylactic versus therapeutic dose anticoagulation effects on survival among critically ill patients with COVID-19

Autor: Wouter S. Hoogenboom, Joyce Q. Lu, Benjamin Musheyev, Lara Borg, Rebeca Janowicz, Stacey Pamlayne, Wei Hou, Tim Q. Duong
Rok vydání: 2021
Předmět:
Male
Viral Diseases
Epidemiology
Anticoagulant Therapy
Kaplan-Meier Estimate
White Blood Cells
Medical Conditions
Risk Factors
Animal Cells
Medicine and Health Sciences
Public and Occupational Health
Hospital Mortality
Lymphocytes
Multidisciplinary
Pharmaceutics
Age Factors
Acute Kidney Injury
Middle Aged
Hospitals
Intensive Care Units
Cardiovascular Therapy
Chemistry
Infectious Diseases
Cardiovascular Diseases
Physical Sciences
Medicine
Female
Cellular Types
Research Article
Chemical Elements
Death Rates
Science
Critical Illness
Immune Cells
Immunology
Sex Factors
Drug Therapy
Population Metrics
Humans
Aged
Proportional Hazards Models
Retrospective Studies
Blood Cells
Population Biology
SARS-CoV-2
Prophylaxis
Anticoagulants
COVID-19
Biology and Life Sciences
Thrombosis
Covid 19
Cell Biology
COVID-19 Drug Treatment
Health Care
Oxygen
Health Care Facilities
Preventive Medicine
Zdroj: PLoS ONE
PLoS ONE, Vol 17, Iss 1, p e0262811 (2022)
ISSN: 1932-6203
Popis: Introduction Although patients with severe COVID-19 are known to be at high risk of developing thrombotic events, the effects of anticoagulation (AC) dose and duration on in-hospital mortality in critically ill patients remain poorly understood and controversial. The goal of this study was to investigate survival of critically ill COVID-19 patients who received prophylactic or therapeutic dose AC and analyze the mortality rate with respect to detailed demographic and clinical characteristics. Materials and methods We conducted a retrospective, observational study of critically ill COVID-19 patients admitted to the ICU at Stony Brook University Hospital in New York who received either prophylactic (n = 158) or therapeutic dose AC (n = 153). Primary outcome was in-hospital death assessed by survival analysis and covariate-adjusted Cox proportional hazard model. Results For the first 3 weeks of ICU stay, we observed similar survival curves for prophylactic and therapeutic AC groups. However, after 3 or more weeks of ICU stay, the therapeutic AC group, characterized by high incidence of acute kidney injury (AKI), had markedly higher death incidence rates with 8.6 deaths (95% CI = 6.2–11.9 deaths) per 1,000 person-days and about 5 times higher risk of death (adj. HR = 4.89, 95% CI = 1.71–14.0, p = 0.003) than the prophylactic group (2.4 deaths [95% CI = 0.9–6.3 deaths] per 1,000 person-days). Among therapeutic AC users with prolonged ICU admission, non-survivors were characterized by older males with depressed lymphocyte counts and cardiovascular disease. Conclusions Our findings raise the possibility that prolonged use of high dose AC, independent of thrombotic events or clinical background, might be associated with higher risk of in-hospital mortality. Moreover, AKI, age, lymphocyte count, and cardiovascular disease may represent important risk factors that could help identify at-risk patients who require long-term hospitalization with therapeutic dose AC treatment.
Databáze: OpenAIRE
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