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Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019

Objective: To compare Anti-Xa directed thromboprophylaxis using low molecular weight heparin (LMWH) (anti-Xa peak goal 0.2-0.5 IU/mL) to alternative anticoagulation strategies in critically ill COVID-19 patients. Methods: This was a retrospective, multicenter, single health-system study. Primary out...

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Autores principales: Mohamed, Adham, Shemanski, Shelby M, Saad, Mohamed O, Ploetz, Jeannette, Haines, Michelle M, Schlachter, Andrew B, Hamarshi, Majdi S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9358597/
https://www.ncbi.nlm.nih.gov/pubmed/35924413
http://dx.doi.org/10.1177/10760296221116350
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author Mohamed, Adham
Shemanski, Shelby M
Saad, Mohamed O
Ploetz, Jeannette
Haines, Michelle M
Schlachter, Andrew B
Hamarshi, Majdi S
author_facet Mohamed, Adham
Shemanski, Shelby M
Saad, Mohamed O
Ploetz, Jeannette
Haines, Michelle M
Schlachter, Andrew B
Hamarshi, Majdi S
author_sort Mohamed, Adham
collection PubMed
description Objective: To compare Anti-Xa directed thromboprophylaxis using low molecular weight heparin (LMWH) (anti-Xa peak goal 0.2-0.5 IU/mL) to alternative anticoagulation strategies in critically ill COVID-19 patients. Methods: This was a retrospective, multicenter, single health-system study. Primary outcomes were thromboembolic events and clinically important bleeding events. Secondary outcomes included dosing comparisons between LMWH cohorts. Main Results: A total of 695 patients were included. No differences were found in the incidence of thrombotic events with any of the dosing strategies. The incidence of major bleeding was significantly higher in the standard dose thromboprophylaxis, intermediate dose subcutaneous heparin (SQH), and therapeutic anticoagulation cohorts. Forty-nine percent of patients within the anti-Xa directed group had their first anti-Xa peak at goal, while 43% were above goal. Patients who had levels above goal had dose modifications made, therefore anti-Xa directed LMWH resulted in significantly lower total daily doses compared to intermediate dose LMWH. Conclusions: Anti-Xa directed LMWH dosing provided comparable thromboprophylaxis with lower total daily doses of LMWH in critically ill COVID-19 patients. Further randomized controlled trials are needed to confirm our findings.
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spelling pubmed-93585972022-08-10 Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019 Mohamed, Adham Shemanski, Shelby M Saad, Mohamed O Ploetz, Jeannette Haines, Michelle M Schlachter, Andrew B Hamarshi, Majdi S Clin Appl Thromb Hemost Original Manuscript Objective: To compare Anti-Xa directed thromboprophylaxis using low molecular weight heparin (LMWH) (anti-Xa peak goal 0.2-0.5 IU/mL) to alternative anticoagulation strategies in critically ill COVID-19 patients. Methods: This was a retrospective, multicenter, single health-system study. Primary outcomes were thromboembolic events and clinically important bleeding events. Secondary outcomes included dosing comparisons between LMWH cohorts. Main Results: A total of 695 patients were included. No differences were found in the incidence of thrombotic events with any of the dosing strategies. The incidence of major bleeding was significantly higher in the standard dose thromboprophylaxis, intermediate dose subcutaneous heparin (SQH), and therapeutic anticoagulation cohorts. Forty-nine percent of patients within the anti-Xa directed group had their first anti-Xa peak at goal, while 43% were above goal. Patients who had levels above goal had dose modifications made, therefore anti-Xa directed LMWH resulted in significantly lower total daily doses compared to intermediate dose LMWH. Conclusions: Anti-Xa directed LMWH dosing provided comparable thromboprophylaxis with lower total daily doses of LMWH in critically ill COVID-19 patients. Further randomized controlled trials are needed to confirm our findings. SAGE Publications 2022-08-04 /pmc/articles/PMC9358597/ /pubmed/35924413 http://dx.doi.org/10.1177/10760296221116350 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Manuscript
Mohamed, Adham
Shemanski, Shelby M
Saad, Mohamed O
Ploetz, Jeannette
Haines, Michelle M
Schlachter, Andrew B
Hamarshi, Majdi S
Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019
title Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019
title_full Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019
title_fullStr Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019
title_full_unstemmed Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019
title_short Anti-Xa Directed Thromboprophylaxis in Critically Ill Patients with Coronavirus Disease 2019
title_sort anti-xa directed thromboprophylaxis in critically ill patients with coronavirus disease 2019
topic Original Manuscript
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9358597/
https://www.ncbi.nlm.nih.gov/pubmed/35924413
http://dx.doi.org/10.1177/10760296221116350
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