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Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19.
- Source :
-
Annals of internal medicine [Ann Intern Med] 2021 May; Vol. 174 (5), pp. 622-632. Date of Electronic Publication: 2021 Jan 26. - Publication Year :
- 2021
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Abstract
- Background: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).<br />Objective: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival.<br />Design: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used.<br />Setting: 67 hospitals in the United States.<br />Participants: Adults with COVID-19 admitted to a participating ICU.<br />Measurements: Time to death, censored at hospital discharge, or date of last follow-up.<br />Results: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]).<br />Limitation: Observational design.<br />Conclusion: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.<br />Primary Funding Source: None.
- Subjects :
- Aged
Anticoagulants adverse effects
Blood Coagulation Disorders mortality
COVID-19 mortality
Critical Illness
Female
Hemorrhage chemically induced
Hemorrhage mortality
Hemorrhage virology
Humans
Intensive Care Units
Male
Middle Aged
SARS-CoV-2
Survival Rate
United States epidemiology
Venous Thromboembolism drug therapy
Venous Thromboembolism mortality
Venous Thromboembolism virology
Anticoagulants administration & dosage
Blood Coagulation Disorders drug therapy
Blood Coagulation Disorders virology
COVID-19 complications
Subjects
Details
- Language :
- English
- ISSN :
- 1539-3704
- Volume :
- 174
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Annals of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 33493012
- Full Text :
- https://doi.org/10.7326/M20-6739