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The authors of this retrospective review evaluated rates of hemorrhage among 324 patients with COVID-19 receiving prophylactic-dose anticoagulation (n=240) compared with an increased dose (ie, subtherapeutic anticoagulation; n=84). The primary outcome, the incidence of major bleeding or clinically relevant non-major bleeding (CRNMB), occurred at an incidence rate of 6.9 per 100 person/months in the prophylactic group compared with 26.4 per 100 person/months in the subtherapeutic group. The incidence of death from any cause was 12.2 per 100 person/months in the prophylactic group and 20.1 per 100 person/months in the subtherapeutic group. The use of subtherapeutic anticoagulation, age >80 years, and dual anti-platelet therapy were independent risk factors for the development of major bleeding and CRNMB.
In this single-center retrospective study of patients with COVID-19 infection admitted to the medical ward, the use of an increased dose of anticoagulation—termed as subtherapeutic anticoagulation—was associated with an increased rate of bleeding and higher rates of all-cause mortality. Larger, propensity-matched or prospective cohort studies should be undertaken to confirm these findings.
– Curtis Lachowiez, MD
This abstract is available on the publisher's site.
COVID-19 is responsible for a worldwide pandemic, with a high rate of morbidity and mortality. The increasing evidence of an associated relevant pro-thrombotic coagulopathy has resulted in an increasing use of antithrombotic doses higher than usual in COVID-19 patients. Information on the benefit/risk ratio of this approach is still lacking.
to assess the incidence of relevant bleeding complications in association with the antithrombotic strategy, and its relationship with the amount of drug.
Consecutive COVID-19 patients admitted between February and April 2020 were included in a retrospective analysis. Major bleedings (MB) and clinical relevant non-major bleeding (CRNMB) were obtained from patient medical records and were adjudicated by an independent committee.
Of the 324 patients who were recruited, 240 had been treated with prophylactic doses and 84 with higher doses of anticoagulants. The rate of the composite endpoint of MB or CRNMB was 6.9 per 100 person/months in patients who had been given prophylactic doses, and 26.4 per 100 persons/months in those who had been prescribed higher doses (HR 3.89; 95%CI, 1.90 to 7.97). The corresponding rates for overall mortality were 12.2 and 20.1 per 100 person/months, respectively.
The rate of relevant bleeding events were high in patients treated with (sub)therapeutic doses of anticoagulants. In the latter group, overall mortality did not differ from that of patients treated with standard prophylactic doses and was even higher. Our result does not support a strategy of giving (sub)therapeutic doses of anticoagulants in non-critically ill patients with COVID-19.
The Hazard of (Sub)Therapeutic Doses of Anticoagulants in Non-Critically Ill Patients With Covid-19: The Padua Province Experience
J. Thromb. Haemost. 2020 Jul 21;[EPub Ahead of Print], R Pesavento, D Ceccato, G Pasquetto, J Monticelli, L Leone, A Frigo, D Gorgi, A Postal, GM Marchese, A Cipriani, A Saller, C Sarais, P Criveller, M Gemelli, F Capone, P Fioretto, C Pagano, M Rossato, A Avogaro, P Simioni, P Prandoni, R Vettor