• Charles Tacquard, Alexandre Mansour, Alexandre Godon, Julien Godet, Julien Poissy, Delphine Garrigue, Eric Kipnis, Rym HamadaSophieSDepartment of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France., Paul Michel Mertes, Annick Steib, Mathilde Ulliel-Roche, Bélaïd Bouhemad, Maxime Nguyen, Florian Reizine, Isabelle Gouin-Thibault, Marie Charlotte Besse, Nived Collercandy, Stefan Mankikian, Jerrold H Levy, Yves Gruel, Pierre Albaladejo, Sophie Susen, Anne Godier, and French Working Group on Perioperative Hemostasis.
• Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
• Chest. 2021 Jun 1; 159 (6): 2417-2427.

BackgroundBecause of the high risk of thrombotic complications (TCs) during SARS-CoV-2 infection, several scientific societies have proposed to increase the dose of preventive anticoagulation, although arguments in favor of this strategy are inconsistent.Research QuestionWhat is the incidence of TC in critically ill patients with COVID-19 and what is the relationship between the dose of anticoagulant therapy and the incidence of TC?Study Design And MethodsAll consecutive patients referred to eight French ICUs for COVID-19 were included in this observational study. Clinical and laboratory data were collected from ICU admission to day 14, including anticoagulation status and thrombotic and hemorrhagic events. The effect of high-dose prophylactic anticoagulation (either at intermediate or equivalent to therapeutic dose), defined using a standardized protocol of classification, was assessed using a time-varying exposure model using inverse probability of treatment weight.ResultsOf 538 patients included, 104 patients experienced a total of 122 TCs with an incidence of 22.7% (95% CI, 19.2%-26.3%). Pulmonary embolism accounted for 52% of the recorded TCs. High-dose prophylactic anticoagulation was associated with a significant reduced risk of TC (hazard ratio, 0.81; 95% CI, 0.66-0.99) without increasing the risk of bleeding (HR, 1.11; 95% CI, 0.70-1.75).InterpretationHigh-dose prophylactic anticoagulation is associated with a reduction in thrombotic complications in critically ill patients with COVID-19 without an increased risk of hemorrhage. Randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results.Trial RegistryClinicalTrials.gov; No.: NCT04405869; URL: www.clinicaltrials.gov.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

23 keywords...

hide…