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. 2023 Apr 18;21(1):42.
doi: 10.1186/s12959-023-00491-6.

Anticoagulation strategy and safety in critically ill COVID-19 patients: a French retrospective multicentre study

Pauline Lamouche-Wilquin  1 , Léa Perrin  1   2 , Morgane Pere  3 , Matthieu Raymond  1 , Pierre Asfar  4 , Cedric Darreau  5 , Florian Reizine  6 , Gwenhaël Colin  7 , Agathe Delbove  8 , Johann Auchabie  9 , Baptiste Hourmant  10 , Aurélien Frérou  11 , Béatrice La Combe  12 , Jean Morin  13 , Pierre Kergoat  14 , Julien Lorber  2 , Pierre-Yves Egreteau  15 , Jérome Souchard  16 , Emmanuel Canet  1 , Jean-Baptiste Lascarrou  17
Affiliations

Anticoagulation strategy and safety in critically ill COVID-19 patients: a French retrospective multicentre study

Pauline Lamouche-Wilquin et al. Thromb J. .

Abstract

Background: Patients with critical illness due to COVID-19 exhibit increased coagulability associated with a high risk of venous thrombo-embolism (VTE). Data on prophylactic anticoagulation for these patients are limited and conflicting. The purpose of this study was to evaluate whether intermediate-dose prophylactic anticoagulation in patients with COVID-19 requiring ICU admission was associated with better outcomes compared to standard-dose prophylactic anticoagulation.

Methods: We retrospectively included adults admitted with severe COVID-19 to any of 15 ICUs, in 2020 or 2021. We compared the groups given intermediate-dose vs. standard-dose prophylactic anticoagulation. The primary outcome was all-cause day-90 mortality. Secondary outcomes were VTE (pulmonary embolism or deep vein thrombosis), ICU stay length, and adverse effects of anticoagulation.

Results: Of 1174 included patients (mean age, 63 years), 399 received standard-dose and 775 intermediate-dose prophylactic anticoagulation. Of the 211 patients who died within 90 days, 86 (21%) received intermediate and 125 (16%) standard doses. After adjustment on early corticosteroid therapy and critical illness severity, there were no significant between-group differences in day-90 mortality (hazard ratio [HR], 0.73; 95%CI, 0.52-1.04; p = 0.09) or ICU stay length (HR, 0.93; 95%CI, 0.79-1.10; p = 0.38). Intermediate-dose anticoagulation was significantly associated with fewer VTE events (HR, 0.55; 95%CI, 0.38-0.80; p < 0.001). Bleeding events occurred in similar proportions of patients in the two groups (odds ratio, 0.86; 95%CI, 0.50-1.47; p = 0.57).

Conclusions: Mortality on day 90 did not differ between the groups given standard-dose and intermediate-dose prophylactic anticoagulation, despite a higher incidence of VTE in the standard-dose group.

Keywords: Anticoagulation strategies; COVID-19; Deep vein thrombosis; Intensive care unit; Pulmonary embolism; Venous thromboembolism.

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Conflict of interest statement

None

Figures

Fig. 1
Fig. 1
Kaplan-Meier plot of day-90 survival
Fig. 2
Fig. 2
Cumulative incidence of venous thromboembolism with death as a competing event
See this image and copyright information in PMC

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