The current status of thrombosis and anticoagulation therapy in patients with COVID-19 in Japan: From the CLOT-COVID study

Nishimoto, Yuji; Yachi, Sen; Takeyama, Makoto; Tsujino, Ichizo; Nakamura, Junichi; Yamamoto, Naoto; Nakata, Hiroko; Ikeda, Satoshi; Umetsu, Michihisa; Aikawa, Shizu; Hayashi, Hiroya; Satokawa, Hirono; Okuno, Yoshinori; Iwata, Eriko; Ogihara, Yoshito; Ikeda, Nobutaka; Kondo, Akane; Iwai, Takehisa; Yamada, Norikazu; Ogawa, Tomohiro; Kobayashi, Takao; Mo, Makoto; Yamashita, Yugo

doi:10.1016/j.jjcc.2022.03.015

Cited by 21 publications

(20 citation statements)

References 36 publications

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“…The design of the study has been reported in detail. 15,16 In the current study, we identified 229 patients with severe COVID-19 on admission who required mechanical ventilation or extracorporeal membrane oxygenation (ECMO), 14,17 after excluding 1,738 patients with mild COVID-19 on admission who did not require oxygen administration and 927 patients with moderate COVID-19 on admission who required oxygen administration (Figure). We further excluded 4 patients who did not receive prophylactic anticoagula- contrast venography) or by autopsy.…”

Section: Study Populationmentioning

confidence: 99%

Therapeutic-Dose vs. Prophylactic-Dose Anticoagulation Therapy for Critically Ill Patients With COVID-19 in a Practice-Based Observational Study

Yamashita

Yachi

Takeyama

et al. 2022

Circ J

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Background:The potential benefit of therapeutic-dose anticoagulation for critically ill patients with coronavirus disease 2019 (COVID-19) is still controversial. Methods and Results:In the CLOT-COVID study, 225 patients with severe COVID-19 on admission requiring mechanical ventilation or extracorporeal membrane oxygenation were divided into patients with therapeutic-dose anticoagulation (N=110) and those with prophylactic-dose anticoagulation (N=115). There was no significant difference in the incidence of thrombosis between the groups (9.1% vs. 7.8%, P=0.73).Conclusions: Among a cohort of critically ill patients with COVID-19, approximately half received therapeutic-dose anticoagulation, although it did not show a potential benefit compared with prophylactic-dose anticoagulation.

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Section: Study Populationmentioning

confidence: 99%

Therapeutic-Dose vs. Prophylactic-Dose Anticoagulation Therapy for Critically Ill Patients With COVID-19 in a Practice-Based Observational Study

Yamashita

Yachi

Takeyama

et al. 2022

Circ J

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“…It enrolled 2894 consecutive hospitalized patients diagnosed with COVID-19 infection by a positive polymerase chain reaction test among 16 centers in Japan from April 2021 to September 2021. The design of the study was previously reported in detail 12,13) . All participating centers' relevant review boards or ethics committees (Supplementary Appendix 1) approved…”

Section: Study Populationmentioning

confidence: 99%

Significant Impact of Age on Mortality and Non-significant Impact of Age on Thrombosis and Major Bleeding in Patients with COVID-19: From the CLOT-COVID Study

Yamashita

Yachi

Takeyama

et al. 2023

JAT

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Aim: There is scarce data on the impact of age on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Method: The CLOT-COVID Study was a retrospective, multicenter cohort study enrolling 2894 consecutive hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021. We divided the entire cohort into five groups according to age strata; -19, 20-39, 40-59, 60-79, and 80-years.Results: Most patients under 19 had mild COVID-19 on admission (99%), while older patients had more severe COVID-19. The incidence rates of clinical outcomes during hospitalization in patients aged ≤ 19, 20-39, 40-59, 60-79, and 80 ≥ years were 0.0%, 0.5%, 2.2%, 2.7%, and 1.5% for thrombosis; 0.0%, 1.2%, 1.5%, 3.4%, and 2.0% for major bleeding; and 0.0%, 0.4%, 2.0%, 12.1%, and 16.8% for all-cause death, respectively. In the stratified analysis according to COVID-19 severity on admission, the incidences of thrombosis were generally higher among patients with more severe status, although those were not significantly different among age strata in all sub-types of COVID-19 severity. However, the incidences of all-cause death were significantly higher with increasing age in all sub-types of COVID-19 severity. Conclusions:In the current large observational study of patients with COVID-19, the risk of mortality became markedly higher with increased age. However, the risks of thrombosis and major bleeding did not necessarily increase as age increases, which seemed to be consistent irrespective of COVID-19 severity on admission.

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“…The CLOT-COVID Study (thrombosis and antiCoaguLa-tiOn Therapy in patients with COVID-19 in Japan Study: UMIN000045800) is a physician-initiated, retrospective, multicenter cohort study on 2894 consecutive patients hospitalized with COVID-19 in 16 Japanese centers between April 2021 and September 2021. The design of the study was previously reported in detail [16,17]. The present study was performed by dedicated members of the Japanese Task Force for Venous Thromboembolism (VTE) and COVID-19 in Japan in a collaborative effort with the Japanese Society of Phlebology and the Japanese Society of Pulmonary Embolism Research.…”

Section: Study Populationmentioning

confidence: 99%

“…Details of the definitions for the diagnosis of complications have been described in our prior publications [16,17]. In brief, hypertension was defined as peripheral blood pressure > 140/90 mmHg or the use of medication for hypertension.…”

Section: Definitions For Patient Characteristicsmentioning

confidence: 99%

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Incidence, risk factors, and clinical impact of major bleeding in hospitalized patients with COVID-19: a sub-analysis of the CLOT-COVID Study

et al. 2022

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Background The coronavirus disease 2019 (COVID-19) causes extensive coagulopathy and a potential benefit of anticoagulation therapy has been documented for prevention of thromboembolic events. Bleeding events has also been reported as a notable complication; whereas, the incidence, risks, and clinical impact of bleeding remain unclear. Method The CLOT-COVID Study was a nationwide, retrospective, multicenter cohort study on consecutive hospitalized patients with COVID-19 in Japan between April 2021 and September 2021. In this sub-analysis, we compared the characteristics of patients with and without major bleeding; moreover, we examined the risk factors for and clinical impact of bleeding events. Results Among 2882 patients with COVID-19, 57 (2.0%) had major bleeding. The incidence of major bleeding increased with COVID-19 severity as follows: 0.5%, 2.3%, and 12.3% in patients with mild, moderate, and severe COVID-19, respectively. COVID-19 severity, history of major bleeding, and anticoagulant type/dose were independently and additively associated with the bleeding incidence. Compared with patients without major bleeding, those with major bleeding exhibited a longer duration of hospitalization (9 [6–14] vs 28 [19–43] days, P < 0.001) and higher mortality during hospitalization (4.9% vs. 35.1%, P < 0.001). Conclusions In the real-world clinical practice, the incidence of major bleeding was not uncommon, especially in patients with severe COVID-19. Independent risk factors for major bleeding included history of major bleeding, COVID-19 severity, and anticoagulant use, which could be associated with poor clinical outcomes including higher mortality. Precise recognition of the risks for bleeding may be helpful for an optimal use of anticoagulants and for better outcomes in patients with COVID-19.

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The current status of thrombosis and anticoagulation therapy in patients with COVID-19 in Japan: From the CLOT-COVID study

Cited by 21 publications

References 36 publications

Therapeutic-Dose vs. Prophylactic-Dose Anticoagulation Therapy for Critically Ill Patients With COVID-19 in a Practice-Based Observational Study

Therapeutic-Dose vs. Prophylactic-Dose Anticoagulation Therapy for Critically Ill Patients With COVID-19 in a Practice-Based Observational Study

Significant Impact of Age on Mortality and Non-significant Impact of Age on Thrombosis and Major Bleeding in Patients with COVID-19: From the CLOT-COVID Study

Incidence, risk factors, and clinical impact of major bleeding in hospitalized patients with COVID-19: a sub-analysis of the CLOT-COVID Study

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