Intermediate-Dose versus Standard-Dose Prophylactic Anticoagulation in Patients with COVID-19 Admitted to the Intensive Care Unit:90-Day Results from the INSPIRATION Randomized Trial
| Autor: | Samuel Z. Goldhaber, Naser Hadavand, Aakriti Gupta, Ajay J. Kirtane, Samira Matin, Seyed Ehsan Parhizgar, Gregory Piazza, Mahesh V. Madhavan, Babak Sharif-Kashani, Benjamin W. Van Tassell, Sahil A. Parikh, Parisa Rezaeifar, Vahid Eslami, Homa Abri, Sanaz Hariri Tabrizi, Mohammad Taghi Beigmohammadi, Atabak Najafi, Paul P. Dobesh, Seyed Hossein Hosseini, Farid Rashidi, Hossein Khalili, Bahram Mohebbi, Ali Dabbagh, Manuel Monreal, Behnood Bikdeli, Hooman Bakhshandeh, Elnaz Zoghi, Rasoul Aliannejad, Majid Maleki, Farnaz Rafiee, Atefeh Abedini, Gregory Y.H. Lip, Samrand Fattah Ghazi, Keivan Gohari Moghadam, Pooya Payandemehr, Shadi Shafaghi, Seyed Masoud Mousavian, Alireza Kashefizadeh, Mahdi Yadollahzadeh, Mohsen Farrokhpour, Shaghayegh Shahmirzaei, Ouria Tahamtan, Sepehr Jamalkhani, Gregg W. Stone, Parham Sadeghipour, Azita Hajhossein Talasaz, Alireza Hajighasemi, David Jiménez, Harlan M. Krumholz, Hamid Reza Rahmani, Sanjum S. Sethi, Ahmad Amin, Hessam Kakavand, Somayeh Lookzadeh, Pardis Sadeghipour, Elahe Baghizadeh, Saeed Sadeghian, Seyed Hashem Sezavar, Taghi Riahi, Keyhan Mohammadi |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Male
Critical Care medicine.medical_treatment Hemorrhage Kaplan-Meier Estimate Iran 030204 cardiovascular system & hematology heparin law.invention Cohort Studies 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Randomized controlled trial law Intensive care Antithrombotic medicine Extracorporeal membrane oxygenation Humans 030212 general & internal medicine Enoxaparin anticoagulation Pandemics Stroke Aged Dose-Response Relationship Drug SARS-CoV-2 business.industry Hazard ratio Anticoagulants COVID-19 Thrombosis enoxaparin Hematology Middle Aged trial medicine.disease Intensive care unit COVID-19 Drug Treatment Intensive Care Units Anesthesia Female business |
| Zdroj: | Bikdeli, B, Talasaz, A H, Rashidi, F, Bakhshandeh, H, Rafiee, F, Rezaeifar, P, Baghizadeh, E, Matin, S, Jamalkhani, S, Tahamtan, O, Sharif-Kashani, B, Beigmohammadi, M T, Farrokhpour, M, Sezavar, S H, Payandemehr, P, Dabbagh, A, Moghadam, K G, Khalili, H, Yadollahzadeh, M, Riahi, T, Abedini, A, Lookzadeh, S, Rahmani, H, Zoghi, E, Mohammadi, K, Sadeghipour, P, Abri, H, Tabrizi, S, Mousavian, S M, Shahmirzaei, S, Amin, A, Mohebbi, B, Parhizgar, S E, Aliannejad, R, Eslami, V, Kashefizadeh, A, Dobesh, P P, Kakavand, H, Hosseini, S H, Shafaghi, S, Ghazi, S F, Najafi, A, Jimenez, D, Gupta, A, Madhavan, M V, Sethi, S S, Parikh, S A, Monreal, M, Hadavand, N, Hajighasemi, A, Maleki, M, Sadeghian, S, Piazza, G, Kirtane, A J, Van Tassell, B W, Stone, G W, Lip, G Y H, Krumholz, H M, Goldhaber, S Z & Sadeghipour, P 2022, ' Intermediate-Dose versus Standard-Dose Prophylactic Anticoagulation in Patients with COVID-19 Admitted to the Intensive Care Unit : 90-Day Results from the INSPIRATION Randomized Trial ', Thrombosis and Haemostasis, vol. 122, no. 1, pp. 131-141 . https://doi.org/10.1055/a-1485-2372 Thrombosis And Haemostasis r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol instname |
| ISSN: | 0340-6245 |
| Popis: | Background Thrombotic complications are considered among the main extrapulmonary manifestations of coronavirus disease 2019 (COVID-19). The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown. Methods This article reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Patients with COVID-19 admitted to intensive care were randomized to intermediate-dose versus standard-dose prophylactic anticoagulation for 30 days, irrespective of hospital discharge status. The primary efficacy outcome was a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause death. The main safety outcome was major bleeding. Results Of 600 randomized patients, 562 entered the modified intention-to-treat analysis (median age [Q1, Q3]: 62 [50, 71] years; 237 [42.2%] women), of whom 336 (59.8%) survived to hospital discharge. The primary outcome occurred in 132 (47.8%) of patients assigned to intermediate dose and 130 (45.4%) patients assigned to standard-dose prophylactic anticoagulation (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.95–1.55, p = 0.11). Findings were similar for other efficacy outcomes, and in the landmark analysis from days 31 to 90 (HR: 1.59, 95% CI: 0.45–5.06). There were 7 (2.5%) major bleeding events in the intermediate-dose group (including 3 fatal events) and 4 (1.4%) major bleeding events in the standard-dose group (none fatal) (HR: 1.82, 95% CI: 0.53–6.24). Conclusion Intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce a composite of death, treatment with ECMO, or venous or arterial thrombosis at 90-day follow-up. |
| Databáze: | OpenAIRE |
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