Low versus high dose anticoagulation in patients with Coronavirus 2019 pneumonia at the time of admission to critical care units: A multicenter retrospective cohort study in the Beaumont healthcare system

Coagulopathy is common in patients with COVID-19. The ideal approach to anticoagulation remains under debate. There is a significant variability in existing protocols for anticoagulation, and these are mostly based on sporadic reports, small studies, and expert opinion. This multicenter retrospectiv...

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Bibliographic Details
Published in:PloS one 2022-03, Vol.17 (3), p.e0265966
Main Authors: Al-Banaa, Kadhim, Alshami, Abbas, Elhouderi, Eiman, Hannoodee, Sally, Hannoodee, Maryam, Al-Hillan, Alsadiq, Alhasson, Hussam, Musa, Faisal, Varon, Joseph, Einav, Sharon
Format: Article
Language:English
Subjects:
Adult
Anticoagulants
Anticoagulants (Medicine)
Anticoagulants - therapeutic use
Biology and Life Sciences
Cohort analysis
Complications and side effects
Coronaviruses
COVID-19
Critical Care
Critical Illness
Delivery of Health Care
Dosage
Drug dosages
Ferritin
Health care
Hospitals
Humans
Intensive care
Intensive Care Units
Intubation
Male
Medicine and Health Sciences
Middle Aged
Mortality
Patient outcomes
Patients
Retrospective Studies
SARS-CoV-2
Thromboembolism
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Summary:Coagulopathy is common in patients with COVID-19. The ideal approach to anticoagulation remains under debate. There is a significant variability in existing protocols for anticoagulation, and these are mostly based on sporadic reports, small studies, and expert opinion. This multicenter retrospective cohort study evaluated the association between anticoagulation dose and inpatient mortality among critically ill COVID-19 patients admitted to the intensive care units (ICUs) or step-down units (SDUs) of eight Beaumont Healthcare hospitals in Michigan, USA from March 10th to April 15th, 2020. Included were 578 patients with a median age of 64 years; among whom, 57.8% were males. Most patients (n = 447, 77.3%) received high dose and one in four (n = 131, 22.7%) received low dose anticoagulation. Overall mortality rate was 41.9% (n = 242). After adjusting for potential confounders (age, sex, race, BMI, ferritin level at hospital admission, intubation, comorbidities, mSOFA, and Padua score), administration of high anticoagulation doses at the time of ICU/SDU admission was associated with decreased inpatient mortality (OR 0.564, 95% CI 0.333-0.953, p = 0.032) compared to low dose. Treatment with high dose anticoagulation at the time of ICU/SDU admission was associated with decreased adjusted mortality among critically ill adult patients with COVID-19.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0265966