AI Article Synopsis
- - The study investigated the effectiveness and safety of step-based dosing of anticoagulants in COVID-19 patients, comparing it to standard prophylactic dosing in a cohort of hospitalized adults with moderate-to-severe illness.
- - Results showed that patients on Pr-to-ThA (prophylactic-switching-to-therapeutic anticoagulants) had a significantly lower risk for severe outcomes like mortality and ICU admission compared to those receiving standard prophylactic anticoagulants. However, those on ThA and Th-to-PrA faced higher risks of bleeding complications.
- - The conclusion emphasizes that while step-based dosing can be beneficial in reducing severe outcomes for COVID-19 patients, it also carries an increased risk of bleeding, warranting careful
Article Abstract
Background: Step-based dosing of anticoagulants has been widely implemented for the treatment of coronavirus disease 2019 (COVID-19), but no studies have comprehensively evaluated the effectiveness and safety of this approach. We aimed to investigate whether step-based dosing of anticoagulants was associated with clinical outcomes in patients with COVID-19 compared with standard prophylactic dosing.
Method: We conducted a retrospective cohort study on adults hospitalized with moderate-to-severe COVID-19. The exposure was step-based dosing of anticoagulants, including prophylactic anticoagulants (PrA), prophylactic-switching-to-therapeutic anticoagulants (Pr-to-ThA), therapeutic anticoagulants (ThA), and therapeutic-switching-to-prophylactic anticoagulants (Th-to-PrA). The primary effectiveness outcome was a composite of all-cause mortality, admission to an intensive care unit (ICU admission), stroke, and venous thromboembolism (VTE). The primary safety outcome was a composite of major and minor/clinically relevant non-major (CRNM) bleeding.
Results: Among 1,081 records for analysis (mean age 59.9, 49.9% being female), during a median follow-up of 15 days, the primary effectiveness outcome occurred in 333 patients (33.5% in the PrA group, 24.6% in the Pr-to-ThA group, 23.7% in the Th-to-PrA group, and 38.0% in the ThA group). Compared with the PrA group, patients receiving Pr-to-ThA had a lower risk of the primary effectiveness outcome (adjusted odds ratio (OR) 0.64, 95% CI: 0.45 to 0.90, Dunnett-adjusted p = 0.01), while those in the Th-to-PrA and ThA were more likely to experience the primary safety outcome (Th-to-PrA, aOR = 3.00, 95% CI: 1.53 to 5.89; ThA, aOR = 3.05, 95% CI: 1.61 to 5.79).
Conclusion: In adults hospitalized with moderate-to-severe COVID-19, compared with standard PrA, the step-based dose-increasing therapy was associated with a lower composite risk of all-cause mortality, ICU admission, stroke, or VTE without evidence of a higher risk of bleeding. ThA dosing was associated with an increase in the bleeding risk, primarily minor and CRNM bleeding.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11411233 | PMC |
| http://dx.doi.org/10.7759/cureus.67256 | DOI Listing |
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