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Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection

BACKGROUND: Patients with severe SARS-CoV-2 infection have been shown to have abnormal coagulation parameters and are at increased risk of thromboembolism. The optimal thromboprophylaxis regimen that minimizes thrombosis without increased risk of serious bleeding is uncertain. OBJECTIVES: To describ...

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Autores principales: Kummer, R.L., Considine, K.A., Rankin, M.A., Hubbard, L.M., Lam, T.S., Thornton, L.T., Lindsay, A.R., Ahiskali, A.S., Leatherman, J.W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Author(s). Published by Elsevier Ltd. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019488/
http://dx.doi.org/10.1016/j.tru.2021.100048
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author Kummer, R.L.
Considine, K.A.
Rankin, M.A.
Hubbard, L.M.
Lam, T.S.
Thornton, L.T.
Lindsay, A.R.
Ahiskali, A.S.
Leatherman, J.W.
author_facet Kummer, R.L.
Considine, K.A.
Rankin, M.A.
Hubbard, L.M.
Lam, T.S.
Thornton, L.T.
Lindsay, A.R.
Ahiskali, A.S.
Leatherman, J.W.
author_sort Kummer, R.L.
collection PubMed
description BACKGROUND: Patients with severe SARS-CoV-2 infection have been shown to have abnormal coagulation parameters and are at increased risk of thromboembolism. The optimal thromboprophylaxis regimen that minimizes thrombosis without increased risk of serious bleeding is uncertain. OBJECTIVES: To describe the efficacy and safety of increased intensity (enhanced) thromboprophylaxis in patients with COVID-19 admitted to the medical intensive care unit (MICU). METHODS: This is a retrospective cohort analysis of patients with a diagnosis of COVID-19 admitted to the MICU of an urban safety net hospital. With the exception of patients being supported with extracorporeal membrane oxygenation or on chronic anticoagulation who received therapeutic dosing of anticoagulation, thromboprophylaxis was given as either enoxaparin or unfractionated heparin in doses higher than those recommended for standard prophylaxis, but lower than those used for therapeutic anticoagulation. MAIN RESULTS: Of the 120 patients managed with an enhanced thromboprophylaxis protocol, 6 (5%) experienced thromboembolism as a result of their COVID-19 disease (1 pulmonary embolus, 4 deep vein thromboses, and 1 arterial embolism). Four patients experienced major bleeding while receiving therapeutic anticoagulation. CONCLUSIONS: In critically ill patients with COVID-19, increased intensity (enhanced) thromboprophylaxis appears to be effective at preventing clinically significant thromboembolic events without an increased risk of serious bleeding.
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spelling pubmed-80194882021-04-06 Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection Kummer, R.L. Considine, K.A. Rankin, M.A. Hubbard, L.M. Lam, T.S. Thornton, L.T. Lindsay, A.R. Ahiskali, A.S. Leatherman, J.W. Thrombosis Update Article BACKGROUND: Patients with severe SARS-CoV-2 infection have been shown to have abnormal coagulation parameters and are at increased risk of thromboembolism. The optimal thromboprophylaxis regimen that minimizes thrombosis without increased risk of serious bleeding is uncertain. OBJECTIVES: To describe the efficacy and safety of increased intensity (enhanced) thromboprophylaxis in patients with COVID-19 admitted to the medical intensive care unit (MICU). METHODS: This is a retrospective cohort analysis of patients with a diagnosis of COVID-19 admitted to the MICU of an urban safety net hospital. With the exception of patients being supported with extracorporeal membrane oxygenation or on chronic anticoagulation who received therapeutic dosing of anticoagulation, thromboprophylaxis was given as either enoxaparin or unfractionated heparin in doses higher than those recommended for standard prophylaxis, but lower than those used for therapeutic anticoagulation. MAIN RESULTS: Of the 120 patients managed with an enhanced thromboprophylaxis protocol, 6 (5%) experienced thromboembolism as a result of their COVID-19 disease (1 pulmonary embolus, 4 deep vein thromboses, and 1 arterial embolism). Four patients experienced major bleeding while receiving therapeutic anticoagulation. CONCLUSIONS: In critically ill patients with COVID-19, increased intensity (enhanced) thromboprophylaxis appears to be effective at preventing clinically significant thromboembolic events without an increased risk of serious bleeding. The Author(s). Published by Elsevier Ltd. 2021-05 2021-04-04 /pmc/articles/PMC8019488/ http://dx.doi.org/10.1016/j.tru.2021.100048 Text en © 2021 The Author(s) Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Kummer, R.L.
Considine, K.A.
Rankin, M.A.
Hubbard, L.M.
Lam, T.S.
Thornton, L.T.
Lindsay, A.R.
Ahiskali, A.S.
Leatherman, J.W.
Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection
title Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection
title_full Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection
title_fullStr Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection
title_full_unstemmed Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection
title_short Enhanced thromboprophylaxis in critically ill patients with COVID-19 infection
title_sort enhanced thromboprophylaxis in critically ill patients with covid-19 infection
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019488/
http://dx.doi.org/10.1016/j.tru.2021.100048
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