The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin

Prandoni, Paolo; Cattelan, Anna Maria; Carrozzi, Laura; Leone, Lucia; Filippi, Lucia; Gaudenzi, Egidio De; Villalta, Sabina; Pesavento, Raffaele; Investigators, Fondacovit

doi:10.1016/j.thromres.2020.09.024

Cited by 17 publications

(10 citation statements)

References 10 publications

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“…Studies of heparin treatment of COVID-19 have shown positive results 103 , 106 (Supplementary Table 1 ), and this is now one of a growing number of agents available to manage COVID-19 either as a prophylactic or therapeutic regimen 108 (Table 1 ). The use of fondaparinux (a selective indirect antithrombin-dependent factor Xa inhibitor) in patients with COVID-19 was reported in two papers, with contrasting results about its safety 109 , 110 . The same applies to direct oral anticoagulants, the use of which in patients with COVID-19 has been little studied to date 111 , 112 .…”

Section: Thrombosis Management In Covid-19mentioning

confidence: 99%

Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19

et al. 2021

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Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with severe disease show hyperactivation of the immune system, which can affect multiple organs besides the lungs. Here, we propose that SARS-CoV-2 infection induces a process known as immunothrombosis, in which activated neutrophils and monocytes interact with platelets and the coagulation cascade, leading to intravascular clot formation in small and larger vessels. Microthrombotic complications may contribute to acute respiratory distress syndrome (ARDS) and other organ dysfunctions. Therapeutic strategies aimed at reducing immunothrombosis may therefore be useful. Several antithrombotic and immunomodulating drugs have been proposed as candidates to treat patients with SARS-CoV-2 infection. The growing understanding of SARS-CoV-2 infection pathogenesis and how it contributes to critical illness and its complications may help to improve risk stratification and develop targeted therapies to reduce the acute and long-term consequences of this disease.

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Section: Thrombosis Management In Covid-19mentioning

confidence: 99%

Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19

et al. 2021

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“…Four out of 22 studies (18%) investigated development of thrombotic complications as a major endpoint [94,96,105,108]. Only in two of them was a multivariable analysis presented, showing a protective effect of anticoagulant agents (Table S1 -118], all retrospective, could be included in this section, of which 13 compared prophylactic dosages vs. subtherapeutic/therapeutic dosages and only two compared prophylactic enoxaparin vs. prophylactic fondaparinux, showing no striking differences in the performed unadjusted comparisons [101,118]. With regard to the comparison of prophylactic vs. therapeutic dosages, mortality was the endpoint (or one of the endpoints) of major interest in 9/13 studies (69%), in most cases with no relevant differences between prophylactic dosages and therapeutic dosages in adjusted comparisons (when available).…”

Section: Comparison Ofmentioning

confidence: 99%

Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP)

et al. 2021

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Introduction: The Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) constituted an expert panel for developing evidence-based guidance for the clinical management of adult patients with coronavirus disease 2019 (COVID-19) outside intensive care units. Methods: Ten systematic literature searches were performed to answer ten different key questions. The retrieved evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). Results and Conclusion: The literature searches mostly assessed the available evidence on the management of COVID-19 patients in terms The Italian Society of Anti-infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) Collaborators members are listed in the Acknowledgements section.

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“…Furthermore, the significant effect of combined LMWH plus methylprednisolone administration (G4) on treatment failure appears to be more consistently in patients with SpO 2 / the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. [16,46].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, several therapeutic interventions have been proposed to mitigate the inflammatory organ injury in viral COVID-19 disease and, consequently, to reduce the hypercoagulable state [13]. Anticoagulant therapy for the management of patients with pneumonia from SARS-CoV-2 infection is widely discussed [10,[14][15][16][17]; recent retrospective studies seem to show a positive effect on the prognosis [10,14,[18][19][20][21]. Moreover, current trials also showed the improvement of clinical outcomes due to the administration of corticosteroids in critical patients [22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Impact of Corticosteroids and Anticoagulant Combined Treatment on Patients Affected by COVID-19 Pneumonia

Anastasio¹,

Scarnecchia²,

Barbuto³

et al. 2021

Res Rev Infect Dis

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Background:The pathogenesis of novel coronavirus disease (COVID-19) includes virus-induced systemic endothelial dysfunction, cytokine storm, and complement cascade hyperactivation, creating massive inflammatory and pro-coagulative states with diffuse vascular thrombosis. Objective: Our observational cohort study analyzed the effectiveness of corticosteroids and anticoagulant combined treatment in patients affected by COVID-19. Design and patients: 423 patients were retrospectively included in the analysis. Patients were divided into four groups: Group 1 (G1, n = 135): No treated; group 2 (G2, n = 8): Treated by methylprednisolone; group 3 (G3, n = 214): Those received low-molecular-weight heparin (LMWH); group 4 (G4, n = 66): Patients treated with combined methylprednisolone plus LMWH. The study outcome was the treatment failure, defined as all-cause of death or Intensive Care Unit (ICU) admission.Results: Mortality and ICU admission rates were 20.6% and 15.1%, respectively. The per-group analysis showed an increased prognosis for G3 (HR 0.59, 95%CI 0.36-0.95, p = 0.03) and G4 (HR 0.47, 95%CI 0.27-0.82, p = 0.007) vs. non-treated group (G1). Combined therapy was especially successful in those patients with the worst respiratory function (SpO 2 / FiO 2 ratio ≤ 220) (HR 0.43, 95%CI 0.24-0.77, p = 0.004). Conclusions:LMWH treatment alone and/or in combination with methylprednisolone seems to be associated with a better outcome, reducing the rate of treatment failure in patients affected by COVID-19 pneumonia.

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The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin

Cited by 17 publications

References 10 publications

Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19

Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19

Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP)

Impact of Corticosteroids and Anticoagulant Combined Treatment on Patients Affected by COVID-19 Pneumonia

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