Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19
Document Type
Article
Publication Date
1-26-2021
Publication Title
Annals of internal medicine
Volume
174
Issue
5
First page number:
622
Last page number:
633
Abstract
BACKGROUND: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19). 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. 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. SETTING: 67 hospitals in the United States. PARTICIPANTS: Adults with COVID-19 admitted to a participating ICU. MEASUREMENTS: Time to death, censored at hospital discharge, or date of last follow-up. 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]). LIMITATION: Observational design. CONCLUSION: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.None.
Disciplines
Internal Medicine
Language
English
Repository Citation
Al-Samkari, H.,
Gupta, S.,
Leaf, R.,
Wang, W.,
Rosovsky, R.,
Brenner, S.,
Hayek, S.,
Berlin, H.,
Kapoor, R.,
Shaefi, S.,
Melamed, M.,
Sutherland, A.,
Radbel, J.,
Green, A.,
Garibaldi, B.,
Srivastava, A.,
Leonberg-Yoo, A.,
Shehata, A.,
Flythe, J.,
Rashidi, A.,
Goyal, N.,
Chan, L.,
Mathews, K.,
Hedayati, S.,
Dy, R.,
Toth-Manikowski, S.,
Zhang, J.,
Mallappallil, M.,
Redfern, R. E.,
Bansal, A. D.
(2021).
Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19.
Annals of internal medicine, 174(5),
622-633.
http://dx.doi.org/10.7326/M20-6739