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Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19
A pro-thrombotic milieu and a higher risk of thrombotic events were observed in patients with CoronaVirus disease-19 (COVID-19). Accordingly, recent data suggested a beneficial role of low molecular weight heparin (LMWH), but the optimal dosage of this treatment is unknown. We evaluated the associat...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919624/ https://www.ncbi.nlm.nih.gov/pubmed/33649979 http://dx.doi.org/10.1007/s11239-021-02401-x |
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author | Mennuni, Marco G. Renda, Giulia Grisafi, Leonardo Rognoni, Andrea Colombo, Crizia Lio, Veronica Foglietta, Melissa Petrilli, Ivan Pirisi, Mario Spinoni, Enrico Azzolina, Danila Hayden, Eyal Aimaretti, Gianluca Avanzi, Gian Carlo Bellan, Mattia Cantaluppi, Vincenzo Capponi, Andrea Castello, Luigi M. D’Ardes, Damiano Corte, Francesco Della Gallina, Sabina Krengli, Marco Malerba, Mario Pierdomenico, Sante D. Savoia, Paola Zeppegno, Patrizia Sainaghi, Pier P. Cipollone, Francesco Patti, Giuseppe |
author_facet | Mennuni, Marco G. Renda, Giulia Grisafi, Leonardo Rognoni, Andrea Colombo, Crizia Lio, Veronica Foglietta, Melissa Petrilli, Ivan Pirisi, Mario Spinoni, Enrico Azzolina, Danila Hayden, Eyal Aimaretti, Gianluca Avanzi, Gian Carlo Bellan, Mattia Cantaluppi, Vincenzo Capponi, Andrea Castello, Luigi M. D’Ardes, Damiano Corte, Francesco Della Gallina, Sabina Krengli, Marco Malerba, Mario Pierdomenico, Sante D. Savoia, Paola Zeppegno, Patrizia Sainaghi, Pier P. Cipollone, Francesco Patti, Giuseppe |
author_sort | Mennuni, Marco G. |
collection | PubMed |
description | A pro-thrombotic milieu and a higher risk of thrombotic events were observed in patients with CoronaVirus disease-19 (COVID-19). Accordingly, recent data suggested a beneficial role of low molecular weight heparin (LMWH), but the optimal dosage of this treatment is unknown. We evaluated the association between prophylactic vs. intermediate-to-fully anticoagulant doses of enoxaparin and in-hospital adverse events in patients with COVID-19. We retrospectively included 436 consecutive patients admitted in three Italian hospitals. Outcome according to the use of prophylactic (4000 IU) vs. higher (> 4000 IU) daily dosage of enoxaparin was evaluated. The primary end-point was in-hospital death. Secondary outcome measures were in-hospital cardiovascular death, venous thromboembolism, new-onset acute respiratory distress syndrome (ARDS) and mechanical ventilation. A total of 287 patients (65.8%) were treated with the prophylactic enoxaparin regimen and 149 (34.2%) with a higher dosing regimen. The use of prophylactic enoxaparin dose was associated with a similar incidence of all-cause mortality (25.4% vs. 26.9% with the higher dose; OR at multivariable analysis, including the propensity score: 0.847, 95% CI 0.400–0.1.792; p = 0.664). In the prophylactic dose group, a significantly lower incidence of cardiovascular death (OR 0.165), venous thromboembolism (OR 0.067), new-onset ARDS (OR 0.454) and mechanical intubation (OR 0.150) was observed. In patients hospitalized for COVID-19, the use of a prophylactic dosage of enoxaparin appears to be associated with similar in-hospital overall mortality compared to higher doses. These findings require confirmation in a randomized, controlled study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11239-021-02401-x. |
format | Online Article Text |
id | pubmed-7919624 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-79196242021-03-02 Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19 Mennuni, Marco G. Renda, Giulia Grisafi, Leonardo Rognoni, Andrea Colombo, Crizia Lio, Veronica Foglietta, Melissa Petrilli, Ivan Pirisi, Mario Spinoni, Enrico Azzolina, Danila Hayden, Eyal Aimaretti, Gianluca Avanzi, Gian Carlo Bellan, Mattia Cantaluppi, Vincenzo Capponi, Andrea Castello, Luigi M. D’Ardes, Damiano Corte, Francesco Della Gallina, Sabina Krengli, Marco Malerba, Mario Pierdomenico, Sante D. Savoia, Paola Zeppegno, Patrizia Sainaghi, Pier P. Cipollone, Francesco Patti, Giuseppe J Thromb Thrombolysis Article A pro-thrombotic milieu and a higher risk of thrombotic events were observed in patients with CoronaVirus disease-19 (COVID-19). Accordingly, recent data suggested a beneficial role of low molecular weight heparin (LMWH), but the optimal dosage of this treatment is unknown. We evaluated the association between prophylactic vs. intermediate-to-fully anticoagulant doses of enoxaparin and in-hospital adverse events in patients with COVID-19. We retrospectively included 436 consecutive patients admitted in three Italian hospitals. Outcome according to the use of prophylactic (4000 IU) vs. higher (> 4000 IU) daily dosage of enoxaparin was evaluated. The primary end-point was in-hospital death. Secondary outcome measures were in-hospital cardiovascular death, venous thromboembolism, new-onset acute respiratory distress syndrome (ARDS) and mechanical ventilation. A total of 287 patients (65.8%) were treated with the prophylactic enoxaparin regimen and 149 (34.2%) with a higher dosing regimen. The use of prophylactic enoxaparin dose was associated with a similar incidence of all-cause mortality (25.4% vs. 26.9% with the higher dose; OR at multivariable analysis, including the propensity score: 0.847, 95% CI 0.400–0.1.792; p = 0.664). In the prophylactic dose group, a significantly lower incidence of cardiovascular death (OR 0.165), venous thromboembolism (OR 0.067), new-onset ARDS (OR 0.454) and mechanical intubation (OR 0.150) was observed. In patients hospitalized for COVID-19, the use of a prophylactic dosage of enoxaparin appears to be associated with similar in-hospital overall mortality compared to higher doses. These findings require confirmation in a randomized, controlled study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11239-021-02401-x. Springer US 2021-03-01 2021 /pmc/articles/PMC7919624/ /pubmed/33649979 http://dx.doi.org/10.1007/s11239-021-02401-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Mennuni, Marco G. Renda, Giulia Grisafi, Leonardo Rognoni, Andrea Colombo, Crizia Lio, Veronica Foglietta, Melissa Petrilli, Ivan Pirisi, Mario Spinoni, Enrico Azzolina, Danila Hayden, Eyal Aimaretti, Gianluca Avanzi, Gian Carlo Bellan, Mattia Cantaluppi, Vincenzo Capponi, Andrea Castello, Luigi M. D’Ardes, Damiano Corte, Francesco Della Gallina, Sabina Krengli, Marco Malerba, Mario Pierdomenico, Sante D. Savoia, Paola Zeppegno, Patrizia Sainaghi, Pier P. Cipollone, Francesco Patti, Giuseppe Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19 |
title | Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19 |
title_full | Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19 |
title_fullStr | Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19 |
title_full_unstemmed | Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19 |
title_short | Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19 |
title_sort | clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for covid-19 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919624/ https://www.ncbi.nlm.nih.gov/pubmed/33649979 http://dx.doi.org/10.1007/s11239-021-02401-x |
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