Details

Autor(en) / Beteiligte

• Al-Samkari, Hanny
• Gupta, Shruti
• Leaf, Rebecca Karp
• Wang, Wei
• Rosovsky, Rachel P
• Brenner, Samantha K
• Hayek, Salim S
• Berlin, Hanna
• Kapoor, Rajat
• Shaefi, Shahzad
• Melamed, Michal L
• Sutherland, Anne
• Radbel, Jared
• Green, Adam
• Garibaldi, Brian T
• Srivastava, Anand
• Leonberg-Yoo, Amanda
• Shehata, Alexandre M
• Flythe, Jennifer E
• Rashidi, Arash
• Goyal, Nitender
• Chan, Lili
• Mathews, Kusum S
• Hedayati, S Susan
• Dy, Rajany
• Toth-Manikowski, Stephanie M
• Zhang, Jingjing
• Mallappallil, Mary
• Redfern, Roberta E
• Bansal, Amar D
• Short, Samuel A P
• Vangel, Mark G
• Admon, Andrew J
• Semler, Matthew W
• Bauer, Kenneth A
• Hernán, Miguel A
• Leaf, David E

Titel

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

Ist Teil von

• Annals of internal medicine, 2021-05, Vol.174 (5), p.622-632

Ort / Verlag

United States

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19). To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival. In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used. 67 hospitals in the United States. Adults with COVID-19 admitted to a participating ICU. Time to death, censored at hospital discharge, or date of last follow-up. Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]). Observational design. Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation. None.