Surveillance or no surveillance for deep venous thrombosis and outcomes of critically ill patients

Arabi, Yaseen M.; Burns, Karen E. A.; Al-Hameed, Fahad; Alsolamy, Sami; Almaani, Mohammed; Mandourah, Yasser; Almekhlafi, Ghaleb A.; Bshabshe, Ali Al; Alshahrani, Mohammed; Khalid, Imran; Hawa, Hassan; Arshad, Zia; Lababidi, Hani; Aithan, Abdulsalam Al; Jose, Jesna; Abdukahil, Sheryl Ann; Afesh, Lara; Al‐Dawood, Abdulaziz

doi:10.1097/md.0000000000012258

Cited by 16 publications

(23 citation statements)

References 13 publications

(14 reference statements)

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“…This is notable because current guidelines in critically ill patients who do not have COVID-19 suggest using pharmacologic prophylaxis alone over combined pharmacologic and mechanical prophylaxis. 47,59 Meanwhile, the guidance document from the AC Forum suggests that in critically ill patients with COVID-19, intermediate or increased intensities of thromboprophylaxis could be used. 55 The authors acknowledge that this was based on expert opinion, and this was published before the results of the INSPIRATION randomized trial were made available.…”

Section: Remarksmentioning

confidence: 99%

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients

et al. 2021

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Background: COVID-19 related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel, including three patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 5, 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021. Results: The panel agreed on one additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19 related-critical illness who do not have confirmed or suspected VTE. Conclusions: This recommendation was based on low certainty in the evidence, underscoring the need for further high-quality, randomized controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence on predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of non-anticoagulant therapies (e.g., antiviral agents, corticosteroids) on thrombotic risk.

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Section: Remarksmentioning

confidence: 99%

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients

et al. 2021

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“…Among critically ill patients who receive pharmacologic thromboprophylaxis, adjunctive IPC cannot result in a significantly lower incidence of proximal lower-limb DVT than pharmacologic thromboprophylaxis alone. 32 Therefore, once the bleeding risk decreases, the pharmacologic thromboprophylaxis should be resumed as earlier as possible.…”

Section: Risk Factors and Risk Assessment For Venous Thromboembolismmentioning

confidence: 99%

Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines

et al. 2020

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Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months, causing millions infected. Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has been frequently reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and coagulation disorders. Based on frontline practical experience and comprehensive literature review, here a panel of experts and physicians from China and Europe developed an evidence and opinion-based consensus on the prophylaxis and management of VTE associated with COVID-19. This statement aims for clinicians treating COVID-19 and provides practical recommendations in detailed situations, for example, how to choose thromboprophylactic measures for patients with diverse severity of disease and bleeding risk, or which kind of anticoagulant should be prescribed. With limited experience on COVID19-associated VTE, this expert consensus statement should be helpful for clinicians worldwide with specific suggestions.

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“…Therefore, it can be speculated that immune de ciency may relate to clinical course of COVID-19 and HBV co-infection after receiving corticosteroid therapy. Similarly, observational studies in patients with SARS and MERS demonstrated corticosteroid therapy association with adverse effects including delayed viral clearance from blood and respiratory tract and increased risk of secondary infection 23,24 . Our results were consistent with previous studies and further supported a role of corticosteroids in prolonging SARS-CoV-2 replication in patients with COVID-19 and HBV co-infection.…”

Section: The Decrease Of Immune Cells Especially Lymphocytes Cd4+ T Cells and Cd8+ T Cells Is Indicated Markermentioning

confidence: 97%

Corticosteroid Treatment in Severe Patients With SARS-CoV-2 and Chronic HBV Co-infection: a Retrospective Multicenter Study

Meng

Chu

Zhang

et al. 2021

Preprint

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Background. The impact of corticosteroids on severe patients with coronavirus disease 2019 (COVID-19)/ chronic hepatitis B virus (HBV) co-infection is currently unknown. We aimed to investigate effect of corticosteroid on these subgroup patients.Methods. In this retrospective multicenter study including 5447 confirmed COVID-19 patients from Jan 1, 2020 to Apr 18, 2020, severe patients with COVID-19/HBV co-infection were identified. To minimize the bias of confounding variables on effect of corticosteroid treatment, inverse probability of treatment weighting (IPTW) based on propensity score was employed.Results. The prevalence of HBV co-infection in hospitalization COVID-19 patients was 4.1%. 105 severe patients with COVID-19/HBV co-infection were enrolled (median age 62 years, 57.1% male). Fifty-five patients received corticosteroid treatment and 50 patients did not. Corticosteroid treatment was associated with high D-dimer level, neutrophil count (all P<0.05). With IPTW analysis, corticosteroid treatment worsen acute liver injury (OR, 1.767, 95%CI, 1.018-3.065, P=0.043). Corticosteroids might delay SARS-CoV-2 viral RNA clearance (OR, 4.963, 95%CI, 2.717-9.065, P <0.001). The 28-day and in-hospital mortality were both significantly higher in corticosteroid treatment group than non-corticosteroid treatment group (OR, 8.738, 95%CI, 2.826-27.022, P <0.001; OR, 10.122, 95%CI, 3.291-31.129, P <0.001, respectively). In multivariable analysis, higher D-dimer level (>1µg/ml) (OR, 10.686, 95%CI, 2.421-47.159, P=0.002) and corticosteroid therapy (OR, 11.236, 95%CI, 1.273-99.154, P=0.029) were independently associated with 28-day mortality. Methylprednisolone dose per day and cumulative dose in non-survivors was significantly higher than in survivors.Conclusions. In severe patients with COVID-19/HBV co-infection, corticosteroid treatment may increase mortality. Therefore, corticosteroid therapy should be prescribed with caution in the subset of patients.

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Surveillance or no surveillance for deep venous thrombosis and outcomes of critically ill patients

Abstract: Supplemental Digital Content is available in the text

Cited by 16 publications

References 13 publications

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients

Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines

Corticosteroid Treatment in Severe Patients With SARS-CoV-2 and Chronic HBV Co-infection: a Retrospective Multicenter Study

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