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Therapeutic Anticoagulation May Be Associated with Reduced 14-day Mortality in Mechanically Ventilated Patients with

Randi Jenkins1, Sahil Sheth1, Breanne Nestor1

  • 1Department of Pharmacy Services, Anne Arundel Medical Center, Annapolis, Maryland.

Innovations in Pharmacy
|May 23, 2022
PubMed

Insights

Therapeutic anticoagulation in mechanically ventilated COVID-19 patients significantly reduced 14-day mortality but increased bleeding risk. This finding is crucial for managing critically ill patients with COVID-19.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Mechanical ventilation and COVID-19 are associated with high risks of mortality and thromboembolic events.
  • Anticoagulation strategies, including therapeutic and prophylactic doses, are critical in managing these patients.
  • Optimal anticoagulation dosing remains a key clinical question in intensive care settings.

Purpose of the Study:

  • To compare the clinical outcomes of therapeutic-dose versus prophylactic-dose anticoagulation in mechanically ventilated patients with COVID-19.
  • To evaluate the impact of different anticoagulation intensities on mortality, length of stay, and thrombotic events.
  • To assess the safety profile, specifically major bleeding, associated with each anticoagulation regimen.

Main Methods:

  • Retrospective analysis of 121 mechanically ventilated COVID-19 patients admitted between [Start Date] and May 31, 2020.
  • Comparison of outcomes between patients receiving therapeutic-dose anticoagulation (n=33) and prophylactic-dose anticoagulation (n=34).
  • Primary endpoint: 14-day mortality. Secondary endpoints: 30-day mortality, hospital length of stay, duration of mechanical ventilation, major bleeding, and new thromboembolic events.

Main Results:

  • Therapeutic anticoagulation significantly reduced 14-day mortality (9.1% vs. 41.2%, p=0.004) and 30-day mortality (24.2% vs. 52.9%, p=0.024) compared to prophylactic dosing.
  • Patients on therapeutic anticoagulation experienced longer hospital length of stay (45.7 vs. 26 days, p=0.003) and mechanical ventilation duration (33.9 vs. 13.3 days, p<0.001).
  • A higher incidence of major bleeding was observed in the therapeutic anticoagulation group.

Conclusions:

  • Therapeutic-dose anticoagulation in mechanically ventilated COVID-19 patients is associated with significantly lower mortality.
  • The benefits of therapeutic anticoagulation must be weighed against an increased risk of major bleeding.
  • Further research is warranted to optimize anticoagulation strategies for critically ill COVID-19 patients.

Keywords:
COVID-19anticoagulationcritical caremechanical ventilationvenous thromboembolism

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