Aggressive Anticoagulation May Decrease Mortality in Obese Critically Ill COVID-19 Patients

Drakos, Panagiotis; Volteas, Panagiotis; Naeem, Zaina; Asencio, Anthony A; Cleri, Nathaniel A; Alkadaa, Leor N; Oganov, Anthony; Gammel, Theresa; Saadon, Jordan R; Bannazadeh, Mohsen; Tassiopoulos, Apostolos K.; Mikell, Charles B.; Rubano, Jerry A.; Pryor, Aurora D.; Spaniolas, Konstantinos; Mofakham, Sima

doi:10.1007/s11695-021-05799-8

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…The same study demonstrated that obesity was not associated with higher mortality rates for critically ill intubated patients than non-obese patients. [75]. All these data reflect the importance of treatment in the evolution of patients with COVID-19, noting remarkable differences between studies conducted at the beginning of the pandemic and later studies.…”

Section: Severe Covid-19 In Higher Obesitymentioning

confidence: 82%

Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review

Vulturar

Crivii

Orășan

et al. 2022

JCM

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Background: During the last years, the COVID-19 pandemic meets the pandemic generated by obesity, raising many questions regarding the outcomes of those with severe forms of infection. Methods: The present systematic review summarises and analyses the data providing evidence for or against the “obesity-paradox” in COVID-19 patients. After applying the inclusion and exclusion criteria, 23 studies were included. We also analysed the presumably underlying basic mechanisms. Results: The patients with a body mass index (BMI) of 30–40 kg/m2 presented severe symptoms that led to intensive care unit (ICU) admission but not increased death rate. Those with a higher degree of obesity, with a BMI higher than 40 kg/m2, led to a rise in the death rate, particularly in young patients. Obesity was associated with a higher rate of ICU admission but was not determined as an independent predictor of increased mortality. In contrast, some studies suggest a strong association between obesity or morbid obesity and the risk of death. Conclusions: The existence of “obesity-paradox” cannot be stated; our study presents obesity as a critical risk factor in the evolution of COVID-19.

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Section: Severe Covid-19 In Higher Obesitymentioning

confidence: 82%

Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review

Vulturar

Crivii

Orășan

et al. 2022

JCM

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“…Our decision to implement an aggressive AC protocol, similar to a protocol proposed by the European Society of Cardiology [ 15 ] was based on our observation that severe arterial and venous thromboembolic events emerged despite the use of routine thromboprophylaxis. Altough the escalation of AC to high intensity thromboprophylaxis and furthermore to therapeutic AC in our cohort of patients was associated with significantly improved organ function and overall survival [ 14 ], and that this practice might be able to balance the negative effects of obesity on the overall patient mortality [ 16 ], the most updated NIH guidelines recommend against this practice and advice over de-escalation of AC once patients get admitted to the ICU [ 13 ]. The cornerstone of these recommendations is based on two randomized controlled clinical trials by the REMAP-CAP/ACTIV-4a/ATTACC investigators who showed that although the strategy to administer therapeutic AC increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support as compared with the administration of prophylactic AC in non-critically ill patients [ 11 ], this benefit disappeared in critically ill patients who received ICU level of care [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Low-molecular-weight heparin compared with unfractionated heparin in critically ill COVID-19 patients

Volteas

Drakos

Alkadaa

et al. 2022

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…This may be explained as follows: Social and Behavioral Aspects of the Individual: the lower inclination of obese persons to engage in physical activity and walks outside the home (e.g., [ 23 – 26 ], which leads, in turn, to reduced interactions with other persons. Behavioral Patterns in the Health System: more aggressive treatment regimens following the conventional definition of obesity as a global pandemic and a risk factor for a long series of health problems, including elevated mortality risk (e.g., [ 22 , 27 , 28 ]. Physiological Considerations: metabolic reserves of obese persons, which may protect against mortality (e.g., [ 20 ]).…”

Section: Discussionmentioning

confidence: 99%

“…Behavioral Patterns in the Health System: more aggressive treatment regimens following the conventional definition of obesity as a global pandemic and a risk factor for a long series of health problems, including elevated mortality risk (e.g., [ 22 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Can Obesity Prevalence Explain COVID-19 Indicators (Cases, Mortality, and Recovery)? A Comparative Study in OECD Countries

et al. 2022

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SARS-CoV-2 virus disease (COVID-19) is declared a global pandemic with multiple risk factors. Obesity is considered by several researchers as one of the serious risk factors for SARS-CoV-2 virus complications based on recent empirical studies. Yet, other scholars argue in favor of the existence of an obesity survival paradox and criticize the former group of studies on the grounds that they lack controls for race, socioeconomic status, or quality of care. The objective of the current study is to analyze the potential relationships between different SARS-CoV-2 virus indicators and obesity on a country-wide level based on an OECD report. In an attempt to test the counterintuitive possibility of an obesity survival paradox, the proposed empirical model relaxes the assumption of monotonic change by applying the quadratic design and testing which one of the two competing models (i.e., quadratic or linear) better fits the data. Findings suggest more complex relationships between SARS-CoV-2 virus indices and obesity rates than previously thought. Consequently, ethical guidelines referring to priority in intubation and intensive care treatments—published by the Israeli Ministry of Health in April 2020—should account for these complex relationships between obesity and SARS-CoV-2 virus. Indeed, there is a linear increase in mortality rate from SARS-CoV-2 virus with an elevated prevalence of obesity. Yet, other indicators, such as the number of infected per 10,00,000 persons, rates of severe SARS-CoV-2 virus cases, rates of recovered SARS-CoV-2 virus patients, and SARS-CoV-2 virus, as the cause of death exhibit quadratic, rather than linear, patterns. The reasons for these nonlinear patterns might be explained by several conditions such as increased metabolic reserves, more aggressive treatment, other non-SARS-CoV-2 virus complications for obese persons, and unidentified factors that should be examined in future research.

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Aggressive Anticoagulation May Decrease Mortality in Obese Critically Ill COVID-19 Patients

Cited by 5 publications

References 19 publications

Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review

Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review

Low-molecular-weight heparin compared with unfractionated heparin in critically ill COVID-19 patients

Can Obesity Prevalence Explain COVID-19 Indicators (Cases, Mortality, and Recovery)? A Comparative Study in OECD Countries

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