D-Dimer-Driven Anticoagulation Reduces Mortality in Intubated COVID-19 Patients: A Cohort Study With a...

Area of Science:

• Critical Care Medicine
• Hematology
• Infectious Diseases

Background:

• Severe COVID-19 infection is associated with hypercoagulability, leading to thromboembolic complications and organ dysfunction.
• The role of anticoagulation intensity in improving outcomes for critically ill COVID-19 patients remains under investigation.

Purpose of the Study:

• To evaluate the efficacy and safety of an escalated anticoagulation protocol driven by D-dimer levels in intubated COVID-19 patients.
• To determine if this protocol reduces thrombotic complications and improves survival compared to standard care.

Main Methods:

• Retrospective review of 240 intubated COVID-19 patients, stratifying 195 into an "ON-protocol" group (n=91) receiving escalated anticoagulation and a "OFF-protocol" control group (n=104) receiving standard thromboprophylaxis.
• Propensity-matched analysis of 124 patients (62 pairs) to control for baseline differences.

Main Results:

• The "ON-protocol" group exhibited significantly lower overall mortality (27.47% vs. 58.66%, P < 0.001) and reduced maximum D-dimer levels.
• Kidney function (serum creatinine) and transfusion requirements were similar, while serious bleeding events were comparable between groups.
• Propensity-matched analysis confirmed improved survival in the "ON-protocol" group (31% vs. 57% mortality).

Conclusions:

• Escalated D-dimer-driven anticoagulation is a safe and effective strategy for managing intubated COVID-19 patients.
• Timely escalation of anticoagulation based on D-dimer levels is critical for improving organ function and reducing mortality in severe COVID-19.
• This approach offers a survival benefit in critically ill COVID-19 patients with hypercoagulability.