Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

被引：95

作者：

Al-Samkari, Hanny ^{[1
,2
]}

Gupta, Shruti ^{[3
,4
]}

Leaf, Rebecca Karp ^{[1
,2
]}

Wang, Wei ^{[5
]}

Rosovsky, Rachel P. ^{[1
,2
]}

Brenner, Samantha K. ^{[6
]}

Hayek, Salim S. ^{[7
]}

Berlin, Hanna ^{[7
]}

Kapoor, Rajat ^{[8
]}

Shaefi, Shahzad ^{[9
]}

Melamed, Michal L. ^{[10
]}

Sutherland, Anne ^{[11
,16
]}

Radbel, Jared ^{[12
]}

Green, Adam ^{[13
]}

Garibaldi, Brian T. ^{[14
]}

Srivastava, Anand ^{[15
]}

Leonberg-Yoo, Amanda ^{[17
]}

Shehata, Alexandre M. ^{[18
]}

Flythe, Jennifer E. ^{[19
,20
]}

Rashidi, Arash ^{[21
,38
]}

Goyal, Nitender ^{[22
]}

Chan, Lili ^{[23
]}

Mathews, Kusum S. ^{[23
]}

Hedayati, S. Susan ^{[24
]}

Dy, Rajany ^{[25
]}

Toth-Manikowski, Stephanie M. ^{[26
]}

Zhang, Jingjing ^{[27
]}

Mallappallil, Mary ^{[28
]}

Redfern, Roberta E. ^{[29
]}

Bansal, Amar D. ^{[30
]}

Short, Samuel A. P. ^{[31
]}

Vangel, Mark G. ^{[32
]}

Admon, Andrew J. ^{[33
]}

Semler, Matthew W. ^{[34
]}

Bauer, Kenneth A. ^{[9
,35
]}

Hernan, Miguel A. ^{[36
,37
,39
,40
]}

Leaf, David E. ^{[3
,4
]}

机构：

[1] Massachusetts Gen Hosp, Zero Emerson Pl,Suite 118,Off 112, Boston, MA 02114 USA

[2] Harvard Med Sch, Zero Emerson Pl,Suite 118,Off 112, Boston, MA 02114 USA

[3] Brigham & Womens Hosp, 75 Francis St,MRB 4, Boston, MA 02115 USA

[4] Harvard Med Sch, Zero Emerson Pl,Suite 118,Off 120, Boston, MA 02114 USA

[5] Brigham & Womens Hosp, 221 Longwood Ave, Boston, MA 02115 USA

[6] Hackensack Meridian Hlth Hackensack Univ Med Ctr, Heart & Vasc Hosp, 30 Prospect Ave, Hackensack, NJ 07601 USA

[7] Univ Michigan, Med Ctr, 1500 E Med Ctr Dr,CVC Suite 2709, Ann Arbor, MI 48109 USA

[8] Indiana Univ Sch Med, 13533 Abercorn St, Carmel, IN 46032 USA

[9] Beth Israel Deaconess Med Ctr, 330 Brookline Ave, Boston, MA 02215 USA

[10] Montefiore Med Ctr, Albert Einstein Coll Med, 1300 Morris Pk Ave,Ullmann 615, Bronx, NY 10461 USA

[11] Rutgers New Jersey Med Sch, 150 Bergen Ave,1 Yellow 354, Newark, NJ 07103 USA

[12] Rutgers Robert Wood Johnson Med Sch, 1 Robert Wood Johnson Pl,MEB 568, New Brunswick, NJ 08901 USA

[13] Cooper Univ Hlth Care, 1 Cooper Plaza, Camden, NJ 08103 USA

[14] Johns Hopkins Sch Med, 1830 East Monument St, Baltimore, MD 21205 USA

[15] Inst Publ Hlth & Med, Ctr Translat Metab & Hlth, 633 N St Clair St,Suite 18-083, Chicago, IL 60611 USA

[16] Northwestern Univ, Feinberg Sch Med, 633 N St Clair St,Suite 18-083, Chicago, IL 60611 USA

[17] Univ Penn, Perelman Sch Med, 51 N 39th St,Med Off Bldg,Suite 240, Philadelphia, PA 19104 USA

[18] Hackensack Meridian Hlth Mountainside Med Ctr, 1 Bay Ave, Glen Ridge, NJ 07028 USA

[19] Univ N Carolina, Univ North Carolina Kidney Ctr, UNC Sch Med, 7024 Burnett Womack,CB 7155, Chapel Hill, NC 27599 USA

[20] Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, 7024 Burnett Womack,CB 7155, Chapel Hill, NC 27599 USA

[21] Univ Hosp Cleveland Med Ctr, Cleveland, OH USA

[22] Tufts Med Ctr, 800 Washington St,Box 391, Boston, MA 02111 USA

[23] Icahn Sch Med Mt Sinai, One Gustave L Levy Pl,Box 1243, New York, NY 10029 USA

[24] Univ Texas Southwestern Med Ctr Dallas, 5909 Harry Hines Blvd,HP05-500, Dallas, TX 75390 USA

[25] Univ Nevada, Southern Nevada Hosp, Univ Med Ctr, 1701 West Charleston Blvd,Suite 230, Las Vegas, NV 89154 USA

[26] Univ Illinois Hosp Chicago, 820 South Wood St,M-C 793, Chicago, IL 60612 USA

[27] Thomas Jefferson Univ Hosp, 833 Chestnut St,Suite 700, Philadelphia, PA 19107 USA

[28] New York City Hlth & Hosp Corp, Kings Cty Hosp Ctr, 826 Albany Ave, Brooklyn, NY 11203 USA

[29] ProMed Toledo Hosp, ProMed Res, 2142 N Cove Blvd,HMT 880, Toledo, OH 43606 USA

[30] Univ Pittsburgh, Med Ctr, 200 Lothrop St,Suite C1104, Pittsburgh, PA 15213 USA

[31] Univ Vermont, Larner Coll Med, 89 Beaumont Ave,Box B3, Burlington, VT 05405 USA

[32] Massachusetts Gen Hosp, Biostat Ctr, 55 Fruit St, Boston, MA 02114 USA

[33] Univ Michigan, 2800 Plymouth Rd,Bldg 16,Room 169c, Ann Arbor, MI 48109 USA

[34] Vanderbilt Univ, Med Ctr, C-1216 Med Ctr North,11161 21st Ave South, Nashville, TN 37232 USA

[35] Harvard Med Sch, 330 Brookline Ave, Boston, MA 02215 USA

[36] Harvard TH Chan Sch Publ Hlth, Boston, MA USA

[37] Harvard Mit Div Hlth Sci & Technol, Boston, MA USA

[38] Univ Hosp Cleveland Med Ctr, 29325 Hlth Campus Dr,Suite 3, Westlake, OH 44145 USA

[39] Harvard TH Chan Sch Publ Hlth, 112 Thorndike St, Brookline, MA 02446 USA

[40] Harvard Mit Div Hlth Sci & Technol, 112 Thorndike St, Brookline, MA 02446 USA

来源：

ANNALS OF INTERNAL MEDICINE | 2021年 / 174卷 / 05期

基金：

美国国家卫生研究院;

关键词：

THROMBOEMBOLISM; EMULATE; RISK;

D O I：

10.7326/M20-6739

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：622 / +

页数：12

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