The hazard of (sub)therapeutic doses of anticoagulants in non-critically ill patients with Covid-19: The Padua province experience
The hazard of (sub)therapeutic doses of anticoagulants in non-critically ill patients with Covid-19: The Padua province experience
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DOI：
10.1111/jth.15022
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发表时间：
2020-08-24
影响因子：
10.4
通讯作者：
Vettor, Roberto
中科院分区：
文献类型：
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作者：
Pesavento, Raffaele;Ceccato, Davide;Vettor, Roberto
背景 2019 年冠状病毒病 (COVID-19) 是一种全球性大流行病，发病率和死亡率很高。越来越多的证据表明相关的血栓前凝血病导致 COVID-19 患者越来越多地使用高于平常的抗血栓剂量。关于这种方法的收益/风险比的信息仍然缺乏。目的探讨与抗栓策略相关的相关出血并发症的发生率及其与用药量的关系。方法对2020年2月至4月期间连续收治的COVID-19患者进行回顾性分析。大出血 (MB) 和临床相关非大出血 (CRNMB) 是从患者病历中获得的，并由独立委员会进行裁决。结果 在招募的 324 名患者中，240 名患者接受了预防剂量的治疗，84 名患者接受了更高剂量的抗凝剂治疗。在接受预防剂量的患者中，MB 或 CRNMB 的复合终点率为每 100 人/月 6.9 例，在服用较高剂量的患者中，MB 或 CRNMB 的复合终点率为每 100 人/月 26.4 例（风险比，3.89；95% 置信区间，1.90-7.97）。相应的总死亡率分别为每 100 人/月 12.2 例和 20.1 例。结论 使用（亚）治疗剂量的抗凝剂治疗的患者相关出血事件的发生率较高。在后一组中，总体死亡率与接受标准预防剂量治疗的患者没有差异，甚至更高。我们的结果不支持对非重症 COVID-19 患者给予（亚）治疗剂量的抗凝剂的策略。
Background Coronavirus Disease 2019 (COVID-19) is responsible for a worldwide pandemic, with a high rate of morbidity and mortality. The increasing evidence of an associated relevant prothrombotic coagulopathy has resulted in an increasing use of antithrombotic doses higher than usual in COVID-19 patients. Information on the benefit/risk ratio of this approach is still lacking. Objective To assess the incidence of relevant bleeding complications in association with the antithrombotic strategy and its relationship with the amount of drug. Methods Consecutive COVID-19 patients admitted between February and April 2020 were included in a retrospective analysis. Major bleedings (MB) and clinically relevant non-major bleeding (CRNMB) were obtained from patient medical records and were adjudicated by an independent committee. Results Of the 324 patients who were recruited, 240 had been treated with prophylactic doses and 84 with higher doses of anticoagulants. The rate of the composite endpoint of MB or CRNMB was 6.9 per 100-person/months in patients who had been given prophylactic doses, and 26.4 per 100-person/months in those who had been prescribed higher doses (hazard ratio, 3.89; 95% confidence interval, 1.90-7.97). The corresponding rates for overall mortality were 12.2 and 20.1 per 100-person/months, respectively. Conclusions The rate of relevant bleeding events was high in patients treated with (sub)therapeutic doses of anticoagulants. In the latter group, overall mortality did not differ from that of patients treated with standard prophylactic doses and was even higher. Our result does not support a strategy of giving (sub)therapeutic doses of anticoagulants in non-critically ill patients with COVID-19.