Retrospective study vs prospective study5/23/2023 On the other end, the HEP-COVID RCT demonstrated significant reduction in thrombosis and mortality in patient who were provided with high-dose anticoagulation. The ACTION trial reported, in patients hospitalized with COVID-19 with elevated D-dimer concentration, therapeutic anticoagulation did not improve clinical outcomes and increased bleeding. Some studies came out supporting therapeutic anticoagulation while others revealed contradictory findings, indicating the possibility that administering high-dose anticoagulation without documented evidence of thrombosis provided no additional benefit. This prompted several observational and randomized controlled trial (RCT) studies comparing high-dose (therapeutic) anticoagulation and low-dose (prophylactic) anticoagulation in the outcome of hospitalized COVID-19 patients. Despite the use of low-dose anticoagulation however, in some studies, a high proportion of patients were still developing life-threatening thrombotic complications suggesting a need for more aggressive anticoagulation in hospitalized COVID-19 patients, especially in critical patients. This finding was further supported by other studies, and as a result standard dose thromboprophylaxis was adopted as part of routine clinical care for COVID-19 patients who require inpatient care. ![]() One of the earliest pieces of evidence on the benefit of anticoagulation for COVID-19 patients was from a retrospective study conducted in Tongji Hospital in Wuhan, China which showed that the 28-day mortality was significantly lower in heparin-users as compared to non-users. Several studies have established that COVID-19 patients are at increased risk of developing thrombotic complications however, the optimal dose of pharmaco-prophylaxis to administer to hospitalized patients is still a topic of controversy due to the ongoing emergence of conflicting evidence. ConclusionĪlthough this study is limited by its observational design, our results are not consistent with current recommendations on anti-coagulation dose for hospitalized patients with COVID-19, necessitating the need for RCT in resource limited settings. Although there were only six major bleeding events in this study, all these were recorded from patients in the therapeutic subgroup, making the difference statistically significant ( p = 0.013). In severe COVID-19 patient group however, the incidence of thrombosis was slightly lower in the therapeutic group as compared with prophylactic group although the difference was not statistically significant (AOR 0.15, 95% CI, 0.02 – 1.20, p = 0.073). After adjustment for several confounders, in critical COVID-19 subgroup, therapeutic dose of anticoagulation was significantly associated with a higher inpatient mortality (AOR 2.27, 95% CI, 1.18-4.35, p = 0.013), whereas in severe COVID-19 subgroup, anticoagulation dosage was not associated with inpatient mortality (OR, 1.02, 95% CI, 0.45 – 2.33, p = 0.958). The demographic and baseline clinical characteristics were roughly similar between the groups. ResultĪ total of 472 hospitalized COVID-19 patients were included in this study, of whom 235 (49.8%) received therapeutic anticoagulation and 237 (50.2%) received prophylactic dose. For critical and severe COVID-19 patients, subgroup analyses were performed using multivariable binary logistic regression model and multivariable Cox regression models. ![]() ![]() The primary outcome measure was in-hospital mortality, and it was assessed using multivariable binary logistic regression and covariate-adjusted Cox Proportional Hazard model. MethodsĪ multi-center retrospective cohort study was conducted to determine the impact of anticoagulation dosage in hospitalized COVID-19 patients in Ethiopia. This study aimed to compare clinical outcomes between patients who received prophylactic anticoagulation and those who received therapeutic anticoagulation. Studies have indicated that hospitalized COVID-19 patients benefit from anticoagulation therapy in terms of survival however, there is an ongoing controversy over the optimum anticoagulant dosage.
0 Comments
Leave a Reply. |