Comparison between standard Vs. Escalated dose venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19: A two centers, observational study

Aljuhani, Ohoud; Sulaiman, Khalid Al; Hafiz, Awattif; Eljaaly, Khalid; Alharbi, Aisha; Algarni, Rahma; Homaid, Sarah Al; Qahtani, Khawla Al; Alsulaiman, Tareq; Vishwakarma, Ramesh; Ghamdi, Ghassan Al; Alalawi, Mai; Korayem, Ghazwa B.

doi:10.1016/j.jsps.2022.01.022

Cited by 6 publications

(10 citation statements)

References 32 publications

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“…However, the absence of a between-group difference in the frequency of thrombo-embolic events suggests potential unrecognised selection bias in this non-randomised study [ 37 ]. Finally, a retrospective review of 565 ICU patients with propensity-score matching compared standard- to intermediate-dose enoxaparin for prophylaxis [ 38 ]. The two groups were not significantly different for 30-day mortality, hospital mortality, VTE, or any thrombo-embolism.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation strategy and safety in critically ill COVID-19 patients: a French retrospective multicentre study

et al. 2023

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Background Patients with critical illness due to COVID-19 exhibit increased coagulability associated with a high risk of venous thrombo-embolism (VTE). Data on prophylactic anticoagulation for these patients are limited and conflicting. The purpose of this study was to evaluate whether intermediate-dose prophylactic anticoagulation in patients with COVID-19 requiring ICU admission was associated with better outcomes compared to standard-dose prophylactic anticoagulation. Methods We retrospectively included adults admitted with severe COVID-19 to any of 15 ICUs, in 2020 or 2021. We compared the groups given intermediate-dose vs. standard-dose prophylactic anticoagulation. The primary outcome was all-cause day-90 mortality. Secondary outcomes were VTE (pulmonary embolism or deep vein thrombosis), ICU stay length, and adverse effects of anticoagulation. Results Of 1174 included patients (mean age, 63 years), 399 received standard-dose and 775 intermediate-dose prophylactic anticoagulation. Of the 211 patients who died within 90 days, 86 (21%) received intermediate and 125 (16%) standard doses. After adjustment on early corticosteroid therapy and critical illness severity, there were no significant between-group differences in day-90 mortality (hazard ratio [HR], 0.73; 95%CI, 0.52–1.04; p = 0.09) or ICU stay length (HR, 0.93; 95%CI, 0.79–1.10; p = 0.38). Intermediate-dose anticoagulation was significantly associated with fewer VTE events (HR, 0.55; 95%CI, 0.38–0.80; p < 0.001). Bleeding events occurred in similar proportions of patients in the two groups (odds ratio, 0.86; 95%CI, 0.50–1.47; p = 0.57). Conclusions Mortality on day 90 did not differ between the groups given standard-dose and intermediate-dose prophylactic anticoagulation, despite a higher incidence of VTE in the standard-dose group.

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Section: Discussionmentioning

confidence: 99%

Anticoagulation strategy and safety in critically ill COVID-19 patients: a French retrospective multicentre study

et al. 2023

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“…If the patient d-dimer level is >1 mcg/mL or if they weigh more than 100 kg, larger doses of > 40 mg per day of enoxaparin are advised. [25] The important primary and secondary outcomes were the ICU LOS and mortality risk, respectively. The medical records of COVID-19 patients were used to extract the ICU LOS and death data.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies [20,[22][23][24] have connected the benefits of AC dosage strategy therapy to decreased mortality in different populations from various regions. However, a few studies [18,25,26] specifically indicated that the therapeutic dose did not lower the overall number of arterial or venous thrombosis deaths. Additional studies [25,27,28] focused on COVID-19 patients in Riyadh and examined various anticoagulant regimens.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation dosage strategy therapy, length of stay, and all-cause mortality in critically ill COVID-19 patients admitted to the intensive care unit

Vennu,

Alshammary

2024

Medicine

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Few studies examined several anticoagulation (AC) dosage strategy therapies for various outcomes among coronavirus disease-2019 (COVID-19) patients. However, this AC dosage strategy therapy has not been investigated to assess the length of stay (LOS) and all-cause mortality among critically ill COVID-19 patients admitted to the intensive care unit (ICU), especially in the eastern province of Saudi Arabia. Thus, this study aimed to examine the association of AC dosage strategy therapy with the LOS and all-cause mortality among critically ill COVID-19 patients admitted to the ICU. We enrolled 170 patients aged 18 years or older, had a confirmed COVID-19, and were hospitalized in a tertiary care facility in the eastern province of Saudi Arabia between March 1, 2020, and January 31, 2021. Patients (n = 56) who received Enoxaparin at a dose of less than or equal to 5000 units of unfractionated heparin thrice daily were categorized as receiving a “prophylaxis” dose. Patients (n = 114) who received a therapeutic dose but not a prophylaxis dose were categorized as receiving a “therapeutic dose.” The 30-day ICU LOS was the main outcome, while all-cause mortality was the secondary outcome. The covariate-adjusted logistic regression analysis revealed that the therapeutic dose was significantly associated with a 1.74-fold longer ICU LOS and 6.60-fold greater mortality risk than the prophylaxis dose. Critically ill COVID-19 patients who received the therapeutic dose had a longer ICU LOS and higher mortality than those who received the prophylaxis dose.

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“…25 Our current study design and methods were based on our previous studies. Details of previous studies' designs and methodology have been published previously [26][27][28][29][30] . This is a multicenter retrospective cohort study of adult patients with COVID-19 admitted to the intensive care units (ICUs) at five centers in Saudi Arabia between March 1, 2020, and July 31, 2021.…”

Section: Methodsmentioning

confidence: 99%

Doxycycline’s Potential Role in Reducing Thrombosis and Mortality in Critically Ill Patients With COVID-19: A Multicenter Cohort Study

Al Sulaiman,

Aljuhani,

Korayem

et al. 2023

Clin Appl Thromb Hemost

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Doxycycline has revealed potential effects in animal studies to prevent thrombosis and reduce mortality. However, less is known about its antithrombotic role in patients with COVID-19. Our study aimed to evaluate doxycycline's impact on clinical outcomes in critically ill patients with COVID-19. A multicenter retrospective cohort study was conducted between March 1, 2020, and July 31, 2021. Patients who received doxycycline in intensive care units (ICUs) were compared to patients who did not (control). The primary outcome was the composite thrombotic events. The secondary outcomes were 30-day and in-hospital mortality, length of stay, ventilator-free days, and complications during ICU stay. Propensity score (PS) matching was used based on the selected criteria. Logistic, negative binomial, and Cox proportional hazards regression analyses were used as appropriate. After PS (1:3) matching, 664 patients (doxycycline n = 166, control n = 498) were included. The number of thromboembolic events was lower in the doxycycline group (OR: 0.54; 95% CI: 0.26-1.08; P = .08); however, it failed to reach to a statistical significance. Moreover, D-dimer levels and 30-day mortality were lower in the doxycycline group (beta coefficient [95% CI]: −0.22 [−0.46, 0.03; P = .08]; HR: 0.73; 95% CI: 0.52-1.00; P = .05, respectively). In addition, patients who received doxycycline had significantly lower odds of bacterial/fungal pneumonia (OR: 0.65; 95% CI: 0.44-0.94; P = .02). The use of doxycycline as adjunctive therapy in critically ill patients with COVID-19 might may be a desirable therapeutic option for thrombosis reduction and survival benefits.

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Comparison between standard Vs. Escalated dose venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19: A two centers, observational study

Cited by 6 publications

References 32 publications

Anticoagulation strategy and safety in critically ill COVID-19 patients: a French retrospective multicentre study

Anticoagulation strategy and safety in critically ill COVID-19 patients: a French retrospective multicentre study

Anticoagulation dosage strategy therapy, length of stay, and all-cause mortality in critically ill COVID-19 patients admitted to the intensive care unit

Doxycycline’s Potential Role in Reducing Thrombosis and Mortality in Critically Ill Patients With COVID-19: A Multicenter Cohort Study

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