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Thromboprophylaxis with standard-dose vs. flexible-dose heparin for hospitalized COVID-19 patients: a target trial emulation.
Martínez-Alés, Gonzalo; Domingo-Relloso, Arce; Quintana-Díaz, Manuel; Fernández-Capitán, Carmen; Hernán, Miguel A.
Afiliación
  • Martínez-Alés G; CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: gmartinezales@hsph.harvard.edu.
  • Domingo-Relloso A; National Center of Epidemiology, Carlos III Health Institute, 28029 Madrid, Spain; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
  • Quintana-Díaz M; La Paz University Hospital, 28029 Madrid, Spain.
  • Fernández-Capitán C; La Paz University Hospital, 28029 Madrid, Spain.
  • Hernán MA; CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
J Clin Epidemiol ; 151: 96-103, 2022 11.
Article en En | MEDLINE | ID: mdl-35987402
OBJECTIVES: To compare mortality of hospitalized COVID-19 patients under two low-molecular weight heparin (LMWH) thromboprophylaxis strategies: standard dose and variable dose (standard dose increased to intermediate dose in the presence of laboratory abnormalities indicating an increased thrombosis risk). STUDY DESIGN AND SETTING: Target trial emulation using observational data from 2,613 adults admitted with a COVID-19 diagnosis in Madrid, Spain between March 16 and April 15, 2020. RESULTS: A total of 1,284 patients were eligible. Among 503 patients without increased baseline thrombotic risk, 28-day mortality risk (95% confidence interval [CI]) was 9.0% (6.6, 11.7) under the standard dose strategy and 5.6% (3.3, 8.3) under the variable dose strategy; risk difference 3.4% (95% CI: -0.24, 6.9); mortality hazard ratio 1.61 (95% CI: 0.97, 2.89). Among 781 patients with increased baseline thrombotic risk, the 28-day mortality risk was 25.8% (22.7, 29.0) under the standard dose strategy and 18.1% (9.3, 28.9) under the intermediate dose strategy; risk difference 7.7% (95% CI: -3.5, 17.2); mortality hazard ratio 1.45 (95% CI: 0.81, 3.17). Major bleeding and LMWH-induced coagulopathy were rare under all strategies. CONCLUSION: Escalating anticoagulation intensity after signs of thrombosis risk may increase the survival of hospitalized COVID-19 patients. However, effect estimates were imprecise and additional studies are warranted.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trombosis / Tromboembolia Venosa / COVID-19 Límite: Adult / Humans Idioma: En Revista: J Clin Epidemiol Asunto de la revista: EPIDEMIOLOGIA Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trombosis / Tromboembolia Venosa / COVID-19 Límite: Adult / Humans Idioma: En Revista: J Clin Epidemiol Asunto de la revista: EPIDEMIOLOGIA Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos