ArticleCritical care (London, England)2020
Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients.
Article in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04412304 (Patient Characteristics, Outcome and Thromboembolic Events Among Adult Critically Ill COVID-19 Patients With Different Anticoagulant Regimes at One of the Biggest Emergency Hospitals in Northern Europe, Sweden), which is not on this map. Cited by 57 papers, 8 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Patient Characteristics, Outcome and Thromboembolic Events Among Adult Critically Ill COVID-19 Patients With Different Anticoagulant Regimes at One of the Biggest Emergency Hospitals in Northern Europe, Sweden
Who cites it
57 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Chronic Anticoagulation in Patients with Atrial Fibrillation and COVID-19: A Systematic Review and Meta-Analysis.Arquivos brasileiros de cardiologia · 2024Pooled it
- Effect of anticoagulation on the incidence of venous thromboembolism, major bleeding, and mortality among hospitalized COVID-19 patients: an updated meta-analysis.Frontiers in cardiovascular medicine · 2024Pooled it
- Efficacy and safety of two heparin regimens for prevention of venous thromboembolism in hospitalized patients with COVID-19: a meta-analysis.Internal and emergency medicine · 2023Pooled it
- Efficacy of different anticoagulant doses for patients with COVID-19: a systematic review and network meta-analysis.Infection · 2022Pooled it
- Anticoagulants for people hospitalised with COVID-19: a rapid reviewThe Cochrane database of systematic reviews · 2022Pooled it
- Development of Evidence-Based COVID-19 Management Guidelines for Local Context: The Methodological Challenges.Global health, epidemiology and genomics · 2022Pooled it
- Mortality and Clinical Interventions in Critically ill Patient With Coronavirus Disease 2019: A Systematic Review and Meta-Analysis.Frontiers in medicine · 2021Pooled it
- Effect of Anticoagulant Administration on the Mortality of Hospitalized Patients With COVID-19: An Updated Systematic Review and Meta-Analysis.Frontiers in medicine · 2021Pooled it
- Incidence and risk factors of deep vein thrombosis in critically ill patients: a systematic review and meta-analysis.Thrombosis journal · 2026Article
- Article
- Effectiveness of Drug Repurposing and Natural Products Against SARS-CoV-2: A Comprehensive Review.Clinical pharmacology : advances and applications · 2024Review
- A case report of spontaneous pectoral hematoma in a male with background antiplatelet therapy after severe COVID-19 infection.Thrombosis journal · 2023Article
- Review
- Prevalence of Thromboembolic Events, Including Venous Thromboembolism and Arterial Thrombosis, in Patients with COVID-19: A Systematic Review with Meta-Analysis.The journal of Tehran Heart Center · 2023Review
- Comparison of safety and efficacy between therapeutic or intermediate versus prophylactic anticoagulation for thrombosis in COVID-19 patients: a systematic review and meta-analysis.Acute and critical care · 2023Article
- [Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study].Enfermedades infecciosas y microbiologia clinica · 2023Article
- Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study.Enfermedades infecciosas y microbiologia clinica (English ed.) · 2023Observational
- Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients.Medicina intensiva · 2023Article
- Comparing Therapeutic versus Prophylactic Enoxaparin Therapy in Severe COVID-19 Patients: A Randomized Clinical Trial.Medical journal of the Islamic Republic of Iran · 2023Article
- Tinzaparin-a review of its molecular profile, pharmacology, special properties, and clinical uses.European journal of clinical pharmacology · 2022Review
Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA substantial proportion of critically ill COVID-19 patients develop thromboembolic complications, but it is unclear whether higher doses of thromboprophylaxis are associated with lower mortality rates. The purpose of the study was to evaluate the association between initial dosing strategy of thromboprophylaxis in critically ill COVID-19 patients and the risk of death, thromboembolism, and bleeding.
methodIn this retrospective study, all critically ill COVID-19 patients admitted to two intensive care units in March and April 2020 were eligible. Patients were categorized into three groups according to initial daily dose of thromboprophylaxis: low (2500-4500 IU tinzaparin or 2500-5000 IU dalteparin), medium (> 4500 IU but < 175 IU/kilogram, kg, of body weight tinzaparin or > 5000 IU but < 200 IU/kg of body weight dalteparin), and high dose (≥ 175 IU/kg of body weight tinzaparin or ≥ 200 IU/kg of body weight dalteparin). Thromboprophylaxis dosage was based on local standardized recommendations, not on degree of critical illness or risk of thrombosis. Cox proportional hazards regression was used to estimate hazard ratios with corresponding 95% confidence intervals of death within 28 days from ICU admission. Multivariable models were adjusted for sex, age, body mass index, Simplified Acute Physiology Score III, invasive respiratory support, and initial dosing strategy of thromboprophylaxis.
resultsA total of 152 patients were included: 67 received low-, 48 medium-, and 37 high-dose thromboprophylaxis. Baseline characteristics did not differ between groups. For patients who received high-dose prophylaxis, mortality was lower (13.5%) compared to those who received medium dose (25.0%) or low dose (38.8%), p = 0.02. The hazard ratio of death was 0.33 (95% confidence intervals 0.13-0.87) among those who received high dose, and 0.88 (95% confidence intervals 0.43-1.83) among those who received medium dose, as compared to those who received low-dose thromboprophylaxis. There were fewer thromboembolic events in the high (2.7%) vs medium (18.8%) and low-dose thromboprophylaxis (17.9%) groups, p = 0.04.
conclusionsAmong critically ill COVID-19 patients with respiratory failure, high-dose thromboprophylaxis was associated with a lower risk of death and a lower cumulative incidence of thromboembolic events compared with lower doses.
trial registrationClinicaltrials.gov NCT04412304 June 2, 2020, retrospectively registered.
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