Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Garrigue, Delphine; Albaladéjo, Pierre; Blais, Normand; Bonhomme, Fanny; Cohen, Ariel; Collet, Jean Philippe; Fontana, Pierre; Huet, D. Garrigue; Godiér, Anne; Godon, Alexandre; Ickx, Brigitte; Laporte, Silvy; Llau, J.V.; Gal, Grégoire Le; Lessire, Sarah; Levy, Jerrold H.; Longrois, Dan; Madi-Jebara, Samia; Mansour, Alexandre; Mazighi, Mikaël; Mismetti, Patrick; Motte, Serge; Mullier, François; Nathan, Nathalie; Pernod, Gilles; Rosencher, Nadia; Roullet, Stéphanie; Roy, Pierre Marie; Schlumberger, S.; Steib, A.; Tacquard, Charles; Testa, Sophie; Vincentelli, André; Zufferey, P.; Borel‐Derlon, Annie; Boissier, Elodie; Dumont, B.; Maistre, Emmanuel de; Gruel, Yves; James, Christie; Lasne, Dominique; Lecompte, T.; Morange, Pierre‐Emmanuel; Nguyên, Philippe; Sié, Pièrre; Siguret, V.; Susen, Sophie

doi:10.1016/j.accpm.2021.100919

Cited by 12 publications

(4 citation statements)

References 47 publications

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“…Moreover, the introduction of therapeutic anticoagulation is associated in these studies with a significant increase in the risk of bleeding events [ 2 ]. These data are in line with recommendations released in April 2020 and updated in 2021 [ 3 ] that propose using anticoagulation according to risk factors described in patients outside of COVID. This underlines the importance of individualizing the assessment of thrombotic risk from the perspective of a targeted initiation of therapeutic anticoagulation in severe COVID-19.…”

Section: Introductionsupporting

confidence: 84%

“…We retrospectively included patients hospitalized in the medical ICUs of two French hospitals (CHU de Lille and Hôpital Foch, Suresnes, France) between September 2020 and March 2022. Included patients met the following criteria: (1) age over 18; (2) admission to ICU for a COVID-19 infection confirmed with reverse transcriptase–polymerase chain reaction (RT-PCR); (3) the presence of respiratory support defining the severity of SARS-CoV-2 infection [ 3 ] within 48 h of admission to the ICU: high-flow nasal oxygen therapy (HFNO), continuous positive airway pressure (CPAP), non-invasive ventilation (NIV), invasive ventilation (IV), or extracorporeal membrane oxygenation (ECMO); (4) dosage of endocan; and (5) a thoracic-computed tomography (CT) scan with injection in the first 48 h of the ICU stay (H0–H48) in order to diagnose a potential PE. Patients with a positive RT-PCR at admission but with an alternative etiology for respiratory distress were not included in the study.…”

Section: Methodsmentioning

confidence: 99%

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Development of a Decision Support Tool for Anticoagulation in Critically Ill Patients Admitted for SARS-CoV-2 Infection: The CALT Protocol

Dubar¹,

Pascreau

Dupont

et al. 2023

Biomedicines

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Severe COVID-19 infections are at high risk of causing thromboembolic events (TEEs). However, the usual exams may be unavailable or unreliable in predicting the risk of TEEs at admission or during hospitalization. We performed a retrospective analysis of two centers (n = 124 patients) including severe COVID-19 patients to determine the specific risk factors of TEEs in SARS-CoV-2 infection at admission and during stays at the intensive care unit (ICU). We used stepwise regression to create two composite scores in order to predict TEEs in the first 48 h (H0–H48) and during the first 15 days (D1–D15) in ICU. We then evaluated the performance of our scores in our cohort. During the period H0–H48, patients with a TEE diagnosis had higher D-Dimers and ferritin values at day 1 (D1) and day 3 (D3) and a greater drop in fibrinogen between D1 and D3 compared with patients without TEEs. Over the period D1-D15, patients with a diagnosis of a TEE showed a more marked drop in fibrinogen and had higher D-Dimers and lactate dehydrogenase (LDH) values at D1 and D3. Based on ROC analysis, the COVID-related acute lung and deep vein thrombosis (CALT) 1 score, calculated at D1, had a diagnostic performance for TEEs at H0–H48, estimated using an area under the curve (AUC) of 0.85 (CI95%: 0.76–0.93, p < 10−3). The CALT 2 score, calculated at D3, predicted the occurrence of TEEs over the period D1-D15 with an estimated AUC of 0.85 (CI95%: 0.77–0.93, p < 10−3). These two scores were used as the basis for the development of the CALT protocol, a tool to assist in the decision to use anticoagulation during severe SARS-CoV-2 infections. The CALT scores showed good performances in predicting the risk of TEEs in severe COVID-19 patients at admission and during ICU stays. They could, therefore, be used as a decision support protocol on whether or not to initiate therapeutic anticoagulation.

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Section: Introductionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Development of a Decision Support Tool for Anticoagulation in Critically Ill Patients Admitted for SARS-CoV-2 Infection: The CALT Protocol

Dubar¹,

Pascreau

Dupont

et al. 2023

Biomedicines

Self Cite

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“…Medical decisions such as the indication for intubation, the use of respiratory support devices, and treatments were left to the discretion of the attending physician. All physicians in the ICUs were affiliated with the French Society of Anesthesia and Critical Care and/or the French Intensive Care Society and followed the national and international guidelines for critically ill and COVID-19 patients' management [17][18][19][20].…”

Section: Clinical Management and Icu Organizationmentioning

confidence: 99%

Management and outcomes of COVID-19 patients admitted in a newly created ICU and an expert ICU, a retrospective observational study

Aarab,

Debourdeau,

Garnier

et al. 2024

Anaesthesia Critical Care & Pain Medicine

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“…These events were mainly of a thrombotic nature but a non-negligible number of cerebral hemorrhagic manifestations was also highlighted [139,140]. The establishment of a state of hypercoagulability during COVID-19 infection seems to play a decisive role in these manifestations so, in these patients, it was carried out early with pharmacological prophylaxis of venous thromboembolism (VTE) and directed against the excessive tendency to induce platelet aggregation [141][142][143][144][145]. Intracranial hemorrhage (ICH) is less frequent than ischemic strokes in COVID-19 patients.…”

Section: Ischemic and Hemorrhagic Stroke In Covid-19 Patientsmentioning

confidence: 99%

Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?

Crispino

2023

Neurology International

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Coagulation and fibrinolytic system disorders are conditions in which the blood’s ability to clot is impaired, resulting in an increased risk of thrombosis or bleeding. Although these disorders are the expression of two opposing tendencies, they can often be associated with or be a consequence of each other, contributing to making the prognosis of acute cerebrovascular events more difficult. It is important to recognize those conditions that are characterized by dual alterations in the coagulation and fibrinolytic systems to reduce the prognostic impact of clinical conditions with difficult treatment and often unfortunate outcomes. Management of these individuals can be challenging, as clinicians must balance the need to prevent bleeding episodes with the potential risk of clot formation. Treatment decisions should be made on an individual basis, considering the specific bleeding disorder, its severity, and the patient’s general medical condition. This review aims to deal with all those forms in which coagulation and fibrinolysis represent two sides of the same media in the correct management of patients with acute neurological syndrome. Precision medicine, personalized treatment, advanced anticoagulant strategies, and innovations in bleeding control represent future directions in the management of these complex pathologies in which stroke can be the evolution of two different acute events or be the first manifestation of an occult or unknown underlying pathology.

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Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Cited by 12 publications

References 47 publications

Development of a Decision Support Tool for Anticoagulation in Critically Ill Patients Admitted for SARS-CoV-2 Infection: The CALT Protocol

Development of a Decision Support Tool for Anticoagulation in Critically Ill Patients Admitted for SARS-CoV-2 Infection: The CALT Protocol

Management and outcomes of COVID-19 patients admitted in a newly created ICU and an expert ICU, a retrospective observational study

Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?

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