Cargando…

Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study

BACKGROUND AND OBJECTIVES: Current clinical guidelines recommend thromboprophylaxis for adults hospitalized with coronavirus disease 2019 (COVID‐19), yet it is unknown whether higher doses of thromboprophylaxis offer benefits beyond standard doses. METHODS: We studied electronic health records from...

Descripción completa

Detalles Bibliográficos
Autores principales: Andersen, Kathleen M., Joseph, Corey S., Mehta, Hemalkumar B., Streiff, Michael B., Betz, Joshua F., Bollinger, Robert C., Fisher, Arielle M., Gupta, Amita, LeMaistre, Charles F., Robinson, Matthew L., Xu, Yanxun, Ng, Derek K., Alexander, G. Caleb, Garibaldi, Brian T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287673/
https://www.ncbi.nlm.nih.gov/pubmed/35859579
http://dx.doi.org/10.1002/rth2.12753
_version_ 1784748298920263680
author Andersen, Kathleen M.
Joseph, Corey S.
Mehta, Hemalkumar B.
Streiff, Michael B.
Betz, Joshua F.
Bollinger, Robert C.
Fisher, Arielle M.
Gupta, Amita
LeMaistre, Charles F.
Robinson, Matthew L.
Xu, Yanxun
Ng, Derek K.
Alexander, G. Caleb
Garibaldi, Brian T.
author_facet Andersen, Kathleen M.
Joseph, Corey S.
Mehta, Hemalkumar B.
Streiff, Michael B.
Betz, Joshua F.
Bollinger, Robert C.
Fisher, Arielle M.
Gupta, Amita
LeMaistre, Charles F.
Robinson, Matthew L.
Xu, Yanxun
Ng, Derek K.
Alexander, G. Caleb
Garibaldi, Brian T.
author_sort Andersen, Kathleen M.
collection PubMed
description BACKGROUND AND OBJECTIVES: Current clinical guidelines recommend thromboprophylaxis for adults hospitalized with coronavirus disease 2019 (COVID‐19), yet it is unknown whether higher doses of thromboprophylaxis offer benefits beyond standard doses. METHODS: We studied electronic health records from 50 091 adults hospitalized with COVID‐19 in the United States between February 2020 and February 2021. We compared standard (enoxaparin 30 or 40 mg/day, fondaparinux 2.5 mg, or heparin 5000 units twice or thrice per day) versus intermediate (enoxaparin 30 or 40 mg twice daily, or up to 1.2 mg/kg of body weight daily, heparin 7500 units thrice per day or heparin 10 000 units twice or thrice per day) thromboprophylaxis. We separately examined risk of escalation to therapeutic anticoagulation, severe disease (first occurrence of high‐flow nasal cannula, noninvasive positive pressure ventilation or invasive mechanical ventilation), and death. To summarize risk, we present hazard ratios (HRs) with 95% confidence intervals (CIs) using adjusted time‐dependent Cox proportional hazards regression models. RESULTS: People whose first dose was high intensity were younger, more often obese, and had greater oxygen support requirements. Intermediate dose thromboprophylaxis was associated with increased risk of therapeutic anticoagulation (HR, 3.39; 95% CI, 3.22‐3.57), severe disease (HR, 1.22; 95% CI, 1.17‐1.28), and death (HR, 1.37; 95% CI, 1.21‐1.55). Increased risks associated with intermediate‐dose thromboprophylaxis persisted in subgroup and sensitivity analyses varying populations and definitions of exposures, outcomes, and covariates. CONCLUSIONS: Our findings do not support routine use of intermediate‐dose thromboprophylaxis to prevent clinical worsening, severe disease, or death among adults hospitalized with COVID‐19.
format Online
Article
Text
id pubmed-9287673
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-92876732022-07-19 Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study Andersen, Kathleen M. Joseph, Corey S. Mehta, Hemalkumar B. Streiff, Michael B. Betz, Joshua F. Bollinger, Robert C. Fisher, Arielle M. Gupta, Amita LeMaistre, Charles F. Robinson, Matthew L. Xu, Yanxun Ng, Derek K. Alexander, G. Caleb Garibaldi, Brian T. Res Pract Thromb Haemost Original Articles BACKGROUND AND OBJECTIVES: Current clinical guidelines recommend thromboprophylaxis for adults hospitalized with coronavirus disease 2019 (COVID‐19), yet it is unknown whether higher doses of thromboprophylaxis offer benefits beyond standard doses. METHODS: We studied electronic health records from 50 091 adults hospitalized with COVID‐19 in the United States between February 2020 and February 2021. We compared standard (enoxaparin 30 or 40 mg/day, fondaparinux 2.5 mg, or heparin 5000 units twice or thrice per day) versus intermediate (enoxaparin 30 or 40 mg twice daily, or up to 1.2 mg/kg of body weight daily, heparin 7500 units thrice per day or heparin 10 000 units twice or thrice per day) thromboprophylaxis. We separately examined risk of escalation to therapeutic anticoagulation, severe disease (first occurrence of high‐flow nasal cannula, noninvasive positive pressure ventilation or invasive mechanical ventilation), and death. To summarize risk, we present hazard ratios (HRs) with 95% confidence intervals (CIs) using adjusted time‐dependent Cox proportional hazards regression models. RESULTS: People whose first dose was high intensity were younger, more often obese, and had greater oxygen support requirements. Intermediate dose thromboprophylaxis was associated with increased risk of therapeutic anticoagulation (HR, 3.39; 95% CI, 3.22‐3.57), severe disease (HR, 1.22; 95% CI, 1.17‐1.28), and death (HR, 1.37; 95% CI, 1.21‐1.55). Increased risks associated with intermediate‐dose thromboprophylaxis persisted in subgroup and sensitivity analyses varying populations and definitions of exposures, outcomes, and covariates. CONCLUSIONS: Our findings do not support routine use of intermediate‐dose thromboprophylaxis to prevent clinical worsening, severe disease, or death among adults hospitalized with COVID‐19. John Wiley and Sons Inc. 2022-07-15 /pmc/articles/PMC9287673/ /pubmed/35859579 http://dx.doi.org/10.1002/rth2.12753 Text en © 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH). https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Andersen, Kathleen M.
Joseph, Corey S.
Mehta, Hemalkumar B.
Streiff, Michael B.
Betz, Joshua F.
Bollinger, Robert C.
Fisher, Arielle M.
Gupta, Amita
LeMaistre, Charles F.
Robinson, Matthew L.
Xu, Yanxun
Ng, Derek K.
Alexander, G. Caleb
Garibaldi, Brian T.
Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study
title Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study
title_full Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study
title_fullStr Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study
title_full_unstemmed Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study
title_short Thromboprophylaxis in people hospitalized with COVID‐19: Assessing intermediate or standard doses in a retrospective cohort study
title_sort thromboprophylaxis in people hospitalized with covid‐19: assessing intermediate or standard doses in a retrospective cohort study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287673/
https://www.ncbi.nlm.nih.gov/pubmed/35859579
http://dx.doi.org/10.1002/rth2.12753
work_keys_str_mv AT andersenkathleenm thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT josephcoreys thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT mehtahemalkumarb thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT streiffmichaelb thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT betzjoshuaf thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT bollingerrobertc thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT fisherariellem thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT guptaamita thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT lemaistrecharlesf thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT robinsonmatthewl thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT xuyanxun thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT ngderekk thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT alexandergcaleb thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy
AT garibaldibriant thromboprophylaxisinpeoplehospitalizedwithcovid19assessingintermediateorstandarddosesinaretrospectivecohortstudy