Therapeutic-Dose vs. Prophylactic-Dose Anticoagulation Therapy for Critically Ill Patients With COVID-19 in a Practice-Based Observational Study

Yamashita, Yugo; Yachi, Sen; Takeyama, Makoto; Nishimoto, Yuji; Tsujino, Ichizo; Nakamura, Junichi; Yamamoto, Naoto; Nakata, Hiroko; Ikeda, Satoshi; Umetsu, Michihisa; Aikawa, Shizu; Hayashi, Hiroya; Satokawa, Hirono; Okuno, Yoshinori; Iwata, Eriko; Ogihara, Yoshito; Ikeda, Nobutaka; Kondo, Akane; Iwai, Takehisa; Yamada, Norikazu; Ogawa, Tomohiro; Kobayashi, Takao; Mo, Makoto

doi:10.1253/circj.cj-22-0209

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…These results indicated that a more aggressive pharmacological thromboprophylaxis might be helpful for the prevention of worsening COVID-19 severity among high-risk patients. As for the therapeutic-dose anticoagulation for critically ill patients with COVID-19, another previous study reported that approximately half of critically ill patients with COVID-19 received therapeutic-dose anticoagulation, although it did not show a potential benefit compared with prophylactic-dose anticoagulation, which seemed to be consistent with the results of RCTs worldwide 64) .…”

Section: Covid-19-related Thrombosis In Japansupporting

confidence: 59%

Thrombosis and Anticoagulation Strategies in Patients with COVID-19 Including Japanese Perspective

Yamashita

Kobayashi

2023

JAT

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Coronavirus disease 2019 (COVID-19) has become a major health problem worldwide since 2020.Although the main pathophysiology of COVID-19 is a respiratory infectious disease, it could also cause cardiovascular complications, including thrombosis. Thus, anticoagulation therapy has been thought to help prevent thrombosis, leading to improved survival. However, to date, several aspects of the optimal anticoagulation strategies for COVID-19 remain unclear. Considering the status of COVID-19-related thrombosis and some domestic issues in Japan, the optimal anticoagulation strategies for COVID-19 might have to be based on Japanese domestic clinical data considering racial difference. Racial disparities in terms of thromboembolic risk have been well known in the pre-COVID-19 era, and the risk of COVID-19-associated thrombosis depending on race could be an important issue. Considering a potential higher risk of bleeding with anticoagulation therapy in the Asian population, it might be important to maintain a good balance between the risks of thrombosis and bleeding. Latest evidences of COVID-19-related thrombosis and anticoagulation strategies, including some domestic issues in Japan, showed a different status of COVID-19-related thrombosis in Japan from that in Western countries, suggesting the potential benefit of different anticoagulation strategies, specifically for the Japanese population. Although these insights could be useful for the consideration of anticoagulation strategies for the Japanese population, the final decision should be based on balancing the benefits and risks of anticoagulation therapy in each patient.

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Section: Covid-19-related Thrombosis In Japansupporting

confidence: 59%

Thrombosis and Anticoagulation Strategies in Patients with COVID-19 Including Japanese Perspective

Yamashita

Kobayashi

2023

JAT

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“…In severe cases, prophylactic doses lead to fewer bleeding complications than therapeutic doses. 4 ) Independent factors for major bleeding have been reported, including a history of major bleeding, severe COVID-19 infection, and use of anticoagulants. 12 ) Anticoagulation in these patient groups requires more caution.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal management strategies for anticoagulation therapy, including the appropriate dosage of anticoagulation therapy, are still being debated around the world. [1][2][3][4] Furthermore, the risk of thrombosis in patients with COVID-19 could widely vary according to ethnic differences and distinct resource availability. Recent studies from Japan reported that the number of patients diagnosed with thrombosis associated with COVID-19 could be small compared with reports from other countries, 5,6) although thrombosis was more common in patients with severe COVID-19 as well as those with several clinical features such as men and high D-dimer values on admission.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features Comparing Arterial Thrombosis and Venous Thromboembolism in Hospitalized Patients with COVID-19: Result from the CLOT-COVID Study

Umetsu

Kanamori

Murakami

et al. 2023

Annals of Vascular Diseases

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Objectives: This study aimed to investigate the clinical features of arterial thrombosis and venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19). Methods: The CLOT-COVID Study was a retrospective, multicenter cohort study that enrolled 2,894 consecutively hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021. We compared the clinical features of arterial thrombosis and VTE. Results: Thrombosis was observed in 55 patients (1.9%) during hospitalization. Arterial thrombosis and VTE occurred in 12 (0.4%) and 36 (1.2%) patients, respectively. Among the 12 patients with arterial thrombosis, 9 (75%), 2 (17%), and 1 developed ischemic cerebral infarction, myocardial infarction, and acute limb ischemia, respectively, and there were five patients (42%) without comorbidities. Among 36 patients with VTE, 19 (53%) and 17 (47%) developed pulmonary embolism (PE) and deep vein thrombosis (DVT), respectively. PE was common in the early stages of hospitalization; whereas, DVT was common beyond the early stages of hospitalization. Conclusion: Among patients with COVID-19, arterial thrombosis was less common than VTE, although ischemic cerebral infarction seemed to be relatively common, and a certain number of patients developed arterial thrombosis even in the absence of known atherosclerosis risk factors.

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“…These evidences indicate that therapeutic-dose anticoagulant therapy is superior to prophylactic-dose anticoagulant therapy in increasing the probability of hospital discharge and reducing mortality. However, recent studies do not favor the use of high dose of anticoagulant therapy (therapeutic-dose or full-dose anticoagulant therapy) in critically ill patients with COVID-19 ( 171 , 172 ). The efficacy of anticoagulant treatment depends on the time of therapy initiation.…”

Section: Treatment Strategymentioning

confidence: 99%

Pathophysiological mechanisms of thrombosis in acute and long COVID-19

Jing

Xiang

et al. 2022

Front. Immunol.

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COVID-19 patients have a high incidence of thrombosis, and thromboembolic complications are associated with severe COVID-19 and high mortality. COVID-19 disease is associated with a hyper-inflammatory response (cytokine storm) mediated by the immune system. However, the role of the inflammatory response in thrombosis remains incompletely understood. In this review, we investigate the crosstalk between inflammation and thrombosis in the context of COVID-19, focusing on the contributions of inflammation to the pathogenesis of thrombosis, and propose combined use of anti-inflammatory and anticoagulant therapeutics. Under inflammatory conditions, the interactions between neutrophils and platelets, platelet activation, monocyte tissue factor expression, microparticle release, and phosphatidylserine (PS) externalization as well as complement activation are collectively involved in immune-thrombosis. Inflammation results in the activation and apoptosis of blood cells, leading to microparticle release and PS externalization on blood cells and microparticles, which significantly enhances the catalytic efficiency of the tenase and prothrombinase complexes, and promotes thrombin-mediated fibrin generation and local blood clot formation. Given the risk of thrombosis in the COVID-19, the importance of antithrombotic therapies has been generally recognized, but certain deficiencies and treatment gaps in remain. Antiplatelet drugs are not in combination with anticoagulant treatments, thus fail to dampen platelet procoagulant activity. Current treatments also do not propose an optimal time for anticoagulation. The efficacy of anticoagulant treatments depends on the time of therapy initiation. The best time for antithrombotic therapy is as early as possible after diagnosis, ideally in the early stage of the disease. We also elaborate on the possible mechanisms of long COVID thromboembolic complications, including persistent inflammation, endothelial injury and dysfunction, and coagulation abnormalities. The above-mentioned contents provide therapeutic strategies for COVID-19 patients and further improve patient outcomes.

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Therapeutic-Dose vs. Prophylactic-Dose Anticoagulation Therapy for Critically Ill Patients With COVID-19 in a Practice-Based Observational Study

Cited by 6 publications

References 21 publications

Thrombosis and Anticoagulation Strategies in Patients with COVID-19 Including Japanese Perspective

Thrombosis and Anticoagulation Strategies in Patients with COVID-19 Including Japanese Perspective

Clinical Features Comparing Arterial Thrombosis and Venous Thromboembolism in Hospitalized Patients with COVID-19: Result from the CLOT-COVID Study

Pathophysiological mechanisms of thrombosis in acute and long COVID-19

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