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No Benefit With Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19
TAKE-HOME MESSAGE
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In this study of 3239 patients (median age, 61 years; 64.5% men) with COVID-19 admitted to the ICU, the authors sought to investigate the incidence of VTE and major bleeding within 14 days after ICU admission, and to examine the impact of early therapeutic anticoagulation on survival. Of these patients, 6.3% developed VTE and 2.8% developed a major bleeding event. Predictors of VTE included higher D-dimer level on ICU admission and male sex. In a subset of 384 patients who received early therapeutic anticoagulation, no difference in risk of death was observed.
- These findings do not suggest a benefit with early therapeutic anticoagulation among critically ill adults with COVID-19.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).
OBJECTIVE
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.
DESIGN
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.
SETTING
67 hospitals in the United States.
PARTICIPANTS
Adults with COVID-19 admitted to a participating ICU.
MEASUREMENTS
Time to death, censored at hospital discharge, or date of last follow-up.
RESULTS
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]).
LIMITATION
Observational design.
CONCLUSION
Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.
Additional Info
Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19
Ann. Intern. Med 2021 Jan 26;[EPub Ahead of Print], H Al-Samkari, S Gupta, RK Leaf, W Wang, RP Rosovsky, SK Brenner, SS Hayek, H Berlin, R Kapoor, S Shaefi, ML Melamed, A Sutherland, J Radbel, A Green, BT Garibaldi, A Srivastava, A Leonberg-Yoo, AM Shehata, JE Flythe, A Rashidi, N Goyal, L Chan, KS Mathews, SS Hedayati, R Dy, SM Toth-Manikowski, J Zhang, M Mallappallil, RE Redfern, AD Bansal, SAP Short, MG Vangel, AJ Admon, MW Semler, KA Bauer, MA Hernán, DE LeafFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.