COVID-19: opening a new paradigm in thromboprophylaxis for critically ill patients?

Ferrandis, Raquel; Llau, Juan V.; Quintana, Manuel; Sierra, P.; Hidalgo, F.; Cassinello, Concepción; Gómez-Luque, A.

doi:10.1186/s13054-020-03052-9

Cited by 11 publications

(13 citation statements)

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“…In seven patients, all autopsies revealed platelet-rich thrombi in the pulmonary, hepatic, renal and cardiac microvasculature [ 26 ]. Indeed, patients with COVID-19 have been found to have a three to six-fold increased risk of thrombosis compared to patients without COVID-19 [ 27 ] and these findings have led to recommendations of thromboprophylaxis in all COVID-19 patients [ 27 , 28 ]. Tang et al [ 29 ] reported that patients with sepsis-induced coagulopathy had a lower mortality if they received heparin for seven or more days compared to those who had heparin therapy for <7 days (40% vs. 64.2%, respectively p = 0.029).…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that direct oral anticoagulants have been associated with an increased risk of major bleeding compared to low molecular weight heparin (LMWH) (relative risk 1.70; 95% CI, 1.02–2.82) and therefore LMWH should be prescribed in inpatients with COVID-19 [ 31 ]. Thrombosis guidelines are under continuous review with current recommendations supporting the routine prescription of thromboprophylaxis for all patients, unless contraindicated [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 Infection and High Intracoronary Thrombus Burden

Kirresh

Coghlan

2021

Cardiovascular Revascularization Medicine

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Coronavirus 2019 (COVID-19) is an acute respiratory disease that has rapidly spread around the world and been declared a global pandemic by the World Health Organization. Emerging evidence demonstrates a strong association with a pro-thrombotic state and we present the first patient admitted with COVID-19 and an inferior ST-segment elevation myocardial infarction (STEMI) with evidence of high intracoronary thrombus burden. We review the mechanism of the high thrombus burden, which may be driven by the significant cytokine storm, endothelial dysfunction, increase risk of coronary plaque rupture and hypercoagulability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

COVID-19 Infection and High Intracoronary Thrombus Burden

Kirresh

Coghlan

2021

Cardiovascular Revascularization Medicine

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“…A common global practice has been to administer escalated intensities of antithrombotic therapy beyond standard prophylactic-dose anticoagulation in hospitalized COVID-19 patients. 10 – 12 To date, there has been little evidence to support this practice. 13 , 14 Some retrospective studies have observed lower mortality rates with therapeutic-dose anticoagulation compared to either prophylactic-dose anticoagulation or no anticoagulation, while others comparing therapeutic- and prophylactic-dose anticoagulation have found no mortality difference.…”

Section: Introductionmentioning

confidence: 99%

Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

Meizlish

Goshua

Liu

et al. 2021

Preprint

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BackgroundThrombotic complications occur at high rates in hospitalized patients with COVID-19, yet the impact of intensive antithrombotic therapy on mortality is uncertain.Research QuestionHow does in-hospital mortality compare with intermediate-versus prophylactic-dose anticoagulation, and separately with in-hospital aspirin versus no antiplatelet therapy, in treatment of COVID-19?Study Design and MethodsUsing data from 2785 hospitalized adult COVID-19 patients, we established two separate, nested cohorts of patients (1) who received intermediate- or prophylactic-dose anticoagulation (“anticoagulation cohort”, N = 1624), or (2) who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy (“aspirin cohort”, N = 1956). Propensity score matching utilizing various markers of illness severity and other patient-specific covariates yielded treatment groups with well-balanced covariates in each cohort. The primary outcome was cumulative incidence of in-hospital death.ResultsAmong propensity score-matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate-compared to prophylactic-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.518 [0.308-0.872]). Among propensity-score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in-hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.522 [0.336-0.812]).InterpretationIn this propensity score-matched, observational study of COVID-19, intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death.Summary conflict of interest statementsNo conflict of interest exists for any author on this manuscript.

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“…Adults hospitalized with COVID-19 are at increased risk of thromboembolic disease ( 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ). This has been attributed to COVID-19-associated blood hyperviscosity ( 9 ) and vascular endotheliïtis ( 10 , 11 , 12 ), which suggests that therapeutic strategies directed solely at the coagulation cascade, may be inadequate. A study of an ICU using routine duplex ultrasonography of the lower extremity in critically-ill COVID-19 patients found a high incidence of venous thromboembolism despite therapeutic anticoagulation ( 13 ).…”

Section: Introductionmentioning

confidence: 99%