Mortality, critical illness, and mechanical ventilation among hospitalized patients with COVID-19 on therapeutic anticoagulants

Patel, Niti G.; Bhasin, Ajay; Angarone, Michael; Cohen, Elaine

doi:10.1016/j.tru.2020.100027

Cited by 8 publications

(9 citation statements)

References 41 publications

(45 reference statements)

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“…Of note, the 8 patients who received fixed therapeutic dose since the beginning of their hospitalization did not show survival benefit compared to those who were uptitrated later in the hospital course. The finding that a fixed therapeutic dose from admission shows no survival benefit is also found in other observational studies and meta-analyses [ 13 , 26 ].…”

Section: Discussionsupporting

confidence: 74%

WITHDRAWN: A dynamic, D-dimer-based thromboprophylaxis strategy in patients with COVID-19

Bhoopat¹,

Martynova²,

Choi³

et al. 2021

Thrombosis Update

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Background While Coronavirus disease 2019 (COVID-19) is associated with increased risk for venous thromboembolism (VTE) during hospitalization despite prophylactic anticoagulation, there is a lack of evidence-based guidelines for dose escalation of anticoagulation for patients hospitalized with COVID-19. Methods This single-center retrospective cohort study was part of a quality improvement program evaluating safety and efficacy of anticoagulation protocols at our large, metropolitan public hospital. We implemented a D-dimer-based guideline for dosing unfractionated heparin (UFH) or low molecular weight heparin (LMWH) in COVID-19 hospitalized patients that allowed for up-titration from standard prophylactic dosing to escalated prophylactic dosing or therapeutic dosing based on patient risk and presence of known or highly suspected VTE. Primary endpoints were International Society on Thrombosis and Haemostasis (ISTH)-defined major and clinically relevant non-major bleeding (CRNMB) events and in-hospital survival. Findings Among 262 COVID-19-infected patients hospitalized between March 15th and June 15th, 2020, 125 (73.1%) were male. Highest anticoagulation dose was: 65.3% prophylactic, 13.4% escalated prophylactic, 21.4% therapeutic. The dose was uptitrated in 83 (31.6%) patients. Bleeding events were comparable between the therapeutic (12.5%) and escalated prophylactic groups (11.4%), but significantly higher than in the prophylactic group (1.2%). In-hospital survival at 28 days was superior among patients whose anticoagulation was uptitrated to either escalated prophylactic or therapeutic (77.6%), compared to those receiving fixed prophylactic (56.7%) or fixed therapeutic (26.7%) dosing (p = 0.001). Conclusion A dynamic, D-dimer based dose escalation of anticoagulation for hospitalized patients with COVID-19 may improve in-hospital mortality without increasing fatal bleeding.

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Section: Discussionsupporting

confidence: 74%

WITHDRAWN: A dynamic, D-dimer-based thromboprophylaxis strategy in patients with COVID-19

Bhoopat¹,

Martynova²,

Choi³

et al. 2021

Thrombosis Update

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“…Some early therapies, such as glucocorticoid administration, remdesivir, monoclonal antibody rescue, and prone position therapy were found to be beneficial when large datasets were interrogated [28,29]. Other practices driven by early observations, such as routine therapeutic anticoagulation or early invasive mechanical ventilation, have been intensively investigated, determined to be lacking an evidence base, and abandoned as part of routine care [30][31][32]. Our data aligned with the latter studies in that we identified no untoward consequences for those with active SARS-CoV-2 infection who underwent appendectomy with active infection compared to those without infection, as well as those who recovered from a prior infection [33].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective

Forssten

Kaplan²,

Tolonen³

et al. 2023

Eur J Trauma Emerg Surg

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Introduction The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.

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“…AC (n = 2) 10,11 D (n = 5) [12][13][14][15][16] HCQ (n = 5) [17][18][19][20][21] RDV (n = 4) [22][23][24][25] T (n = 5) [26][27][28][29][30] Change in primary outcome, n (%) 0 (0) 0 (0) 1 ( 20) 0 (0) 0 (0) Change in effect size of primary outcome, n (%) 20) 1 ( 20) 1 ( 25) 0 (0)…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

Comparison of COVID-19 Preprint and Peer-Reviewed Versions of Studies on Therapies for Critically Ill Patients

Morin

Padki

Wong

et al. 2023

J Intensive Care Med

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Purpose Significant increases in the volume of preprint articles due to the COVID-19 pandemic, we examined the reliability of preprint articles compared to their peer-reviewed publications. Materials and Methods Preprint articles evaluating experimental studies of select treatment options (anticoagulation, dexamethasone, hydroxychloroquine, remdesivir, and tocilizumab) for COVID-19 in the critically ill, available in a peer-reviewed publication were screened for inclusion within Altmetric (n = 2040). A total of 40 articles met inclusion criteria, with 21 being randomly selected for evaluation. The primary outcome of this evaluation was a change in a study's reported primary outcome or statistical significance between preprint and peer-reviewed articles. Secondary outcomes included changes in primary/secondary outcome effect size and change in study conclusion. Results One article (4.8%, 95% CI 0.12%-23.8%) had a change in the primary outcome. Seven articles (33.3%, 95% CI 14.6%-57.0%) had a change in the primary outcome's effect measure. Five studies (23.8%, 95% CI 8.2%-47.2%) had changes in statistical significance of at least one secondary outcome. Four studies (19.0%, 95% CI 5.4%-41.9%) had a change in study conclusion. Conclusions In preprint articles of COVID-19 treatments, the provided primary outcome is generally reliable, while interpretation of secondary outcomes should be made with caution, while awaiting completion of the peer-review process.

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Mortality, critical illness, and mechanical ventilation among hospitalized patients with COVID-19 on therapeutic anticoagulants

Cited by 8 publications

References 41 publications

WITHDRAWN: A dynamic, D-dimer-based thromboprophylaxis strategy in patients with COVID-19

WITHDRAWN: A dynamic, D-dimer-based thromboprophylaxis strategy in patients with COVID-19

Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective

Comparison of COVID-19 Preprint and Peer-Reviewed Versions of Studies on Therapies for Critically Ill Patients

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