Higher Intensity Thromboprophylaxis Regimens and Pulmonary Embolism in Critically Ill Coronavirus Disease 2019 Patients

Taccone, Fabio Silvio; Gevenois, Pierre Alain; Peluso, Lorenzo; Pletchette, Zoe; Lheureux, Olivier; Brasseur, Alexandre; Garufi, Alessandra; Talamonti, Marta; Motte, Serge; Nobile, Leda; Grimaldi, David; Créteur, Jacques; Vincent, Jean‐Louis

doi:10.1097/ccm.0000000000004548

Cited by 55 publications

(68 citation statements)

References 12 publications

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“… 39 – 41 Retrospective studies of therapeutic- compared to prophylactic-dose anticoagulation have reported mixed effects on mortality, while only two small studies have examined outcomes with intermediate- compared to prophylactic-dose anticoagulation, largely focusing on venous thromboembolism rates, again with conflicting results. 7 , 15 , 16 , 18 – 22 , 42 , 43 More recently, the ACTIV randomized clinical trial showed futility of therapeutic-compared to prophylactic-dose anticoagulation in critically ill COVID-19 patients, leading to a pause in further recruitment of critically ill patients for that trial. Our analysis is the first large-scale study to specifically examine intermediate- and prophylactic-dose anticoagulation in COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

Meizlish

Goshua

Liu

et al. 2021

Preprint

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BackgroundThrombotic complications occur at high rates in hospitalized patients with COVID-19, yet the impact of intensive antithrombotic therapy on mortality is uncertain.Research QuestionHow does in-hospital mortality compare with intermediate-versus prophylactic-dose anticoagulation, and separately with in-hospital aspirin versus no antiplatelet therapy, in treatment of COVID-19?Study Design and MethodsUsing data from 2785 hospitalized adult COVID-19 patients, we established two separate, nested cohorts of patients (1) who received intermediate- or prophylactic-dose anticoagulation (“anticoagulation cohort”, N = 1624), or (2) who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy (“aspirin cohort”, N = 1956). Propensity score matching utilizing various markers of illness severity and other patient-specific covariates yielded treatment groups with well-balanced covariates in each cohort. The primary outcome was cumulative incidence of in-hospital death.ResultsAmong propensity score-matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate-compared to prophylactic-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.518 [0.308-0.872]). Among propensity-score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in-hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.522 [0.336-0.812]).InterpretationIn this propensity score-matched, observational study of COVID-19, intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death.Summary conflict of interest statementsNo conflict of interest exists for any author on this manuscript.

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Section: Discussionmentioning

confidence: 99%

Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

Meizlish

Goshua

Liu

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…96 Another study found that among 49 mechanically ventilated patients, 33% were diagnosed with PE and that the use of high intensity thromboprophylaxis was associated with a lower occurrence of PE (2/18; 11%) than a standard regimen (11/22; 50%—OR 0.13 [0.02-0.69]; p = .02). 97…”

Section: Methylprednisolone and Covid-19mentioning

confidence: 99%

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

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In December 2019, COVID-19, a severe respiratory illness caused by the new coronavirus SARS-CoV-2 (COVID-19) emerged in Wuhan, China. The greatest impact that COVID-19 had was on intensive care units (ICUs), given that approximately 20% of hospitalized cases developed acute respiratory failure (ARF) requiring ICU admission. Based on the assumption that COVID-19 represented a viral pneumonia and no anti-coronaviral therapy existed, nearly all national and international health care societies’ recommended “supportive care only” avoiding other therapies outside of randomized controlled trials, with a specific prohibition against the use of corticosteroids in treatment. However, early studies of COVID-19-associated ARF reported inexplicably high mortality rates, with frequent prolonged durations of mechanical ventilation (MV), even from centers expert in such supportive care strategies. These reports led the authors to form a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance (www.flccc.net ). The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of “ what was working and what wasn’t working,” the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and co-interventions (MATH+). This manuscript reviews the scientific and clinical rationale behind MATH+ based on published in-vitro, pre-clinical, and clinical data in support of each medicine, with a special emphasis of studies supporting their use in the treatment of patients with viral syndromes and COVID-19 specifically. The review concludes with a comparison of published multi-national mortality data with MATH+ center outcomes.

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“…In addition, corticosteroids (dexamethasone), antibiotics, and LMWH in a prophylactic or therapeutic dose are recommended [13]. Taccone et al documented that a high-dose regimen of thromboprophylaxis therapy may decrease the occurrence of venous thromboembolic disease in critically ill SARS-CoV-2 patients [14]. We used LMWH in a prophylactic dose due to previous exclusion of pulmonary embolism and prompt clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Lung Disease in a Patient with Pulmonary Sarcoidosis—Case Report

Opoka¹,

Wyrostkiewicz²,

Winek³

et al. 2020

Advances in Respiratory Medicine

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the recently identified cause of the current pandemic. In patients with chronic respiratory lung diseases, SARS-CoV-2 may result in significant morbidity and increased mortality. We present a case of a 69-year-old male with stage II pulmonary sarcoidosis who had been under observation for 30 months without immunosuppressive treatment. He then developed severe SARS-CoV-2 disease with typical radiological and laboratory findings. Therapy with oxygen, antibiotics, low-molecular-weight heparin in a prophylactic dose, and dexamethasone resulted in marked clinical improvement. We will discuss the rationale for corticosteroid use in both SARS-CoV-2 disease and in SARS-CoV-2 disease that is complicating comorbid sarcoidosis.

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Higher Intensity Thromboprophylaxis Regimens and Pulmonary Embolism in Critically Ill Coronavirus Disease 2019 Patients

Abstract: Supplemental Digital Content is available in the text.

Cited by 55 publications

References 12 publications

Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

SARS-CoV-2 Lung Disease in a Patient with Pulmonary Sarcoidosis—Case Report

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