Anticoagulation in COVID-19: a single-center retrospective study

Roomi, Sohaib; Saddique, Maryum; Ullah, Waqas; Haq, Shujaul; Ashfaq, Ammar; Madara, John; Boigon, Margot

doi:10.1080/20009666.2020.1835297

Cited by 12 publications

(9 citation statements)

References 11 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among the 8318 articles initially retrieved through our literature search, 21 fulfilled the inclusion criteria and were included in our analysis [ 11 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 .…”

Section: Resultsmentioning

confidence: 99%

“…The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 . A total of 7 studies reported data for intermediate versus prophylactic dose [ 11 , 27 , 28 , 29 , 30 , 34 , 35 ], while 17 studies reported data for therapeutic versus prophylactic dose of thromboprophylaxis [ 12 , 23 , 24 , 25 , 26 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Three studies contributed data for both intermediate versus prophylactic and therapeutic versus prophylactic dose analyses [ 29 , 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…There were 2 randomized [ 12 , 33 ] and 15 observational studies [ 23 , 24 , 25 , 26 , 29 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] ( n = 7776, weighted age 64 years, males 54%, ICU 21%) that reported the RR for death in patients with COVID-19 administered therapeutic versus prophylactic dose of thromboprophylaxis. Meta-analysis of these 17 studies (use of adjusted estimates for non-randomized) revealed a pooled adjusted RR for death at 0.73 (95% CI 0.47, 1.14; I 2 87%) ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Kyriakoulis

Trontzas

Rapti

et al. 2021

JCM

View full text Add to dashboard Cite

Thromboprophylaxis in hospitalized patients with COVID-19 has been associated with a survival benefit and is strongly recommended. However, the optimal dose of thromboprophylaxis remains unclear. A systematic review and meta-analysis (PubMed/EMBASE) of studies comparing high (intermediate or therapeutic dose) versus standard (prophylactic dose) intensity of thrombo-prophylaxis with regard to outcome of hospitalized patients with COVID-19 was performed. Randomized and non-randomized studies that provided adjusted effect size estimates were included. Meta-analysis of 7 studies comparing intermediate versus prophylactic dose of thromboprophylaxis (2 randomized and 5 observational, n = 2009, weighted age 61 years, males 61%, ICU 53%) revealed a pooled adjusted relative risk (RR) for death at 0.56 (95% confidence intervals (CI) 0.34, 0.92) in favor of the intermediate dose. For the same comparison arms, the pooled RR for venous thromboembolism was 0.84 (95% CI 0.54, 1.31), and for major bleeding events was 1.63 (95% CI 0.79, 3.37). Meta-analysis of 17 studies comparing therapeutic versus prophylactic dose of thromboprophylaxis (2 randomized and 15 observational, n = 7776, weighted age 64 years, males 54%, ICU 21%) revealed a pooled adjusted RR for death at 0.73 (95% CI 0.47, 1.14) for the therapeutic dose. An opposite trend was observed in the unadjusted analysis of 15 observational studies (RR 1.24 (95% CI 0.88, 1.74)). For the same comparison arms, the pooled RR for venous thromboembolism was 1.13 (95% CI 0.52, 2.48), and for major bleeding events 3.32 (95% CI 2.51, 4.40). In conclusion, intermediate compared with standard prophylactic dose of thromboprophylaxis appears to be rather safe and is associated with additional survival benefit, although most data are derived from observational retrospective analyses. Randomized studies are needed to define the optimal thromboprophylaxis in hospitalized patients with COVID-19.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Kyriakoulis

Trontzas

Rapti

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…Nevertheless, our study demonstrated that low-dose ASA plus ENX was associated with decreased mechanical ventilation needs. This reflects the protective and desirable effect [38].…”

Section: Discussionmentioning

confidence: 91%

Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study

et al. 2021

View full text Add to dashboard Cite

Background and Objective Low-dose acetylsalicylic acid (ASA, aspirin) is a well-known and frequently studied drug for primary and secondary prevention of disease due to its anti-inflammatory and coagulopathic effects. COVID-19 complications are attributed to the role of thrombo-inflammation. Studies regarding the use of low-dose ASA in COVID-19 are limited. For this reason, we propose that the use of low-dose ASA may have protective effects in COVID-19-related thromboembolism and lung injury. This study was conducted to assess the efficacy of low-dose ASA compared with enoxaparin, an anticoagulant, for the prevention of thrombosis and mechanical ventilation. Methods We conducted a retrospective cohort study on COVID-19-confirmed hospitalized patients at the Mansoura University Quarantine Hospital, outpatients, and home-isolated patients from September to December 2020 in Mansoura governorate, Egypt. Binary logistic regression analysis was used to assess the effect of ASA compared with enoxaparin on thromboembolism, and mechanical ventilation needs. Results This study included 225 COVID-19 patients. Use of ASA-only (81-162 mg orally daily) was significantly associated with reduced thromboembolism (OR 0.163, p = 0.020), but both low-dose ASA and enoxaparin, and enoxaparin-only (0.5 mg/kg subcutaneously (SC) daily as prophylactic dose or 1 mg/kg SC every 12 hours as therapeutic dose) were more protective (odds ratio [OR] 0.010, OR 0.071, respectively, p < 0.001). Neither ASA-only nor enoxaparin-only were associated with a reduction in mechanical ventilation needs. Concomitant use of low-dose ASA and enoxaparin was associated with reduced mechanical ventilation (OR 0.032, 95% CI 0.004-0.226, p = 0.001). Conclusions Low-dose ASA-only use may reduce the incidence of COVID-19-associated thromboembolism, but the reduction may be less than that of enoxaparin-only, and both ASA and enoxaparin. Concomitant use of ASA and enoxaparin demonstrates promising results with regard to the reduction of thrombotic events, and mechanical ventilation needs.

show abstract

“…Al conducted a retrospective cohort consisting of 176 patients admitted to the hospital for COVID-19 infection and reported that therapeutic anticoagulation was associated with a lower rate of in-hospital mortality compared to prophylactic anticoagulation (OR 3.05, 95% CI 1.15-8.10, p = 0.04). 32 Pre-print publications by the multiplatform collaborative clinical trial (ACTIV-4a [NCT04505774], REMAP-CAP [NCT02735707], ATTACC [NCT04372589]) that aimed to assess the benefit of full dose anticoagulation to treat non critically-ill or critically ill adults hospitalized for COVID-19, compared to prophylactic dosing showed that therapeutic anticoagulation had a trend toward less mortality in non-critically ill patients. 33 Moreover, therapeutic dose anticoagulation has also been shown to reduce endothelial cell lesion (p = 0.02) which could also reduce the thromboembolic risk of COVID-19, suggesting another therapeutic target for anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

Combined Anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalized COVID-19 patients: a propensity matched cohort study

Matli

Chamoun

Fares

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: COVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population. Methods: A retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, ICU admission, or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation. Results: 242 patients were included in the study and divided into 4 subgroups: therapeutic anticoagulation (TAC), prophylactic anticoagulation + antiplatelet (PACAP), therapeutic anticoagulation + antiplatelet (TACAP), and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable cox regression analysis and propensity matching were done and showed when compared to PAC, TACAP and TAC were associated with less in-hospital all cause mortality with an adjusted hazard ratio (aHR) of 0.113 (95% confidence interval (CI) 0.028-0.449) and 0.126 (95% CI, 0.028-0.528) respectively. The number needed to treat (NNT) in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI, 0.014-0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission, or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation. Conclusion: The use of combined anticoagulant and antiplatelet agents or therapeutic anticoagulation alone in hospitalized COVID-19 patients was associated with a better outcome in comparison to prophylactic anticoagulation alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomized controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using therapeutic anticoagulation in the management of patients with COVID-19 infection.

show abstract

Anticoagulation in COVID-19: a single-center retrospective study

Cited by 12 publications

References 11 publications

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study

Combined Anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalized COVID-19 patients: a propensity matched cohort study

Contact Info

Product

Resources

About