Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19
BACKGROUND: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).
OBJECTIVE: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival.
DESIGN: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used.
SETTING: 67 hospitals in the United States.
PARTICIPANTS: Adults with COVID-19 admitted to a participating ICU.
MEASUREMENTS: Time to death, censored at hospital discharge, or date of last follow-up.
RESULTS: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]).
LIMITATION: Observational design.
CONCLUSION: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.
PRIMARY FUNDING SOURCE: None.
| Errataetall: |
ErratumIn: Ann Intern Med. 2021 Jun;174(6):888. - PMID 34126034 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:174 |
|---|---|
| Enthalten in: |
Annals of internal medicine - 174(2021), 5 vom: 25. Mai, Seite 622-632 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Al-Samkari, Hanny [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anticoagulants |
|---|
| Anmerkungen: |
Date Completed 28.05.2021 Date Revised 30.03.2024 published: Print-Electronic ErratumIn: Ann Intern Med. 2021 Jun;174(6):888. - PMID 34126034 Citation Status MEDLINE |
|---|
| doi: |
10.7326/M20-6739 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM320550648 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM320550648 | ||
| 003 | DE-627 | ||
| 005 | 20240330235706.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.7326/M20-6739 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1357.xml |
| 035 | |a (DE-627)NLM320550648 | ||
| 035 | |a (NLM)33493012 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Al-Samkari, Hanny |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19 |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 28.05.2021 | ||
| 500 | |a Date Revised 30.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: Ann Intern Med. 2021 Jun;174(6):888. - PMID 34126034 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19) | ||
| 520 | |a OBJECTIVE: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival | ||
| 520 | |a DESIGN: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used | ||
| 520 | |a SETTING: 67 hospitals in the United States | ||
| 520 | |a PARTICIPANTS: Adults with COVID-19 admitted to a participating ICU | ||
| 520 | |a MEASUREMENTS: Time to death, censored at hospital discharge, or date of last follow-up | ||
| 520 | |a RESULTS: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]) | ||
| 520 | |a LIMITATION: Observational design | ||
| 520 | |a CONCLUSION: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation | ||
| 520 | |a PRIMARY FUNDING SOURCE: None | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 700 | 1 | |a Gupta, Shruti |e verfasserin |4 aut | |
| 700 | 1 | |a Leaf, Rebecca Karp |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Wei |e verfasserin |4 aut | |
| 700 | 1 | |a Rosovsky, Rachel P |e verfasserin |4 aut | |
| 700 | 1 | |a Brenner, Samantha K |e verfasserin |4 aut | |
| 700 | 1 | |a Hayek, Salim S |e verfasserin |4 aut | |
| 700 | 1 | |a Berlin, Hanna |e verfasserin |4 aut | |
| 700 | 1 | |a Kapoor, Rajat |e verfasserin |4 aut | |
| 700 | 1 | |a Shaefi, Shahzad |e verfasserin |4 aut | |
| 700 | 1 | |a Melamed, Michal L |e verfasserin |4 aut | |
| 700 | 1 | |a Sutherland, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Radbel, Jared |e verfasserin |4 aut | |
| 700 | 1 | |a Green, Adam |e verfasserin |4 aut | |
| 700 | 1 | |a Garibaldi, Brian T |e verfasserin |4 aut | |
| 700 | 1 | |a Srivastava, Anand |e verfasserin |4 aut | |
| 700 | 1 | |a Leonberg-Yoo, Amanda |e verfasserin |4 aut | |
| 700 | 1 | |a Shehata, Alexandre M |e verfasserin |4 aut | |
| 700 | 1 | |a Flythe, Jennifer E |e verfasserin |4 aut | |
| 700 | 1 | |a Rashidi, Arash |e verfasserin |4 aut | |
| 700 | 1 | |a Goyal, Nitender |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Lili |e verfasserin |4 aut | |
| 700 | 1 | |a Mathews, Kusum S |e verfasserin |4 aut | |
| 700 | 1 | |a Hedayati, S Susan |e verfasserin |4 aut | |
| 700 | 1 | |a Dy, Rajany |e verfasserin |4 aut | |
| 700 | 1 | |a Toth-Manikowski, Stephanie M |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jingjing |e verfasserin |4 aut | |
| 700 | 1 | |a Mallappallil, Mary |e verfasserin |4 aut | |
| 700 | 1 | |a Redfern, Roberta E |e verfasserin |4 aut | |
| 700 | 1 | |a Bansal, Amar D |e verfasserin |4 aut | |
| 700 | 1 | |a Short, Samuel A P |e verfasserin |4 aut | |
| 700 | 1 | |a Vangel, Mark G |e verfasserin |4 aut | |
| 700 | 1 | |a Admon, Andrew J |e verfasserin |4 aut | |
| 700 | 1 | |a Semler, Matthew W |e verfasserin |4 aut | |
| 700 | 1 | |a Bauer, Kenneth A |e verfasserin |4 aut | |
| 700 | 1 | |a Hernán, Miguel A |e verfasserin |4 aut | |
| 700 | 1 | |a Leaf, David E |e verfasserin |4 aut | |
| 700 | 0 | |a STOP-COVID Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Walther, Carl P |e investigator |4 oth | |
| 700 | 1 | |a Anumudu, Samaya J |e investigator |4 oth | |
| 700 | 1 | |a Arunthamakun, Justin |e investigator |4 oth | |
| 700 | 1 | |a Kopecky, Kathleen F |e investigator |4 oth | |
| 700 | 1 | |a Milligan, Gregory P |e investigator |4 oth | |
| 700 | 1 | |a McCullough, Peter A |e investigator |4 oth | |
| 700 | 1 | |a Nguyen, Thuy-Duyen |e investigator |4 oth | |
| 700 | 1 | |a Shaefi, Shahzad |e investigator |4 oth | |
| 700 | 1 | |a Krajewski, Megan L |e investigator |4 oth | |
| 700 | 1 | |a Shankar, Sidharth |e investigator |4 oth | |
| 700 | 1 | |a Pannu, Ameeka |e investigator |4 oth | |
| 700 | 1 | |a Valencia, Juan D |e investigator |4 oth | |
| 700 | 1 | |a Bauer, Kenneth A |e investigator |4 oth | |
| 700 | 1 | |a Waikar, Sushrut S |e investigator |4 oth | |
| 700 | 1 | |a Kibbelaar, Zoe A |e investigator |4 oth | |
| 700 | 1 | |a Athavale, Ambarish M |e investigator |4 oth | |
| 700 | 1 | |a Hart, Peter |e investigator |4 oth | |
| 700 | 1 | |a Upadhyay, Shristi |e investigator |4 oth | |
| 700 | 1 | |a Vohra, Ishaan |e investigator |4 oth | |
| 700 | 1 | |a Oyintayo, Ajiboye |e investigator |4 oth | |
| 700 | 1 | |a Green, Adam |e investigator |4 oth | |
| 700 | 1 | |a Rachoin, Jean-Sebastien |e investigator |4 oth | |
| 700 | 1 | |a Schorr, Christa A |e investigator |4 oth | |
| 700 | 1 | |a Shea, Lisa |e investigator |4 oth | |
| 700 | 1 | |a Edmonston, Daniel L |e investigator |4 oth | |
| 700 | 1 | |a Mosher, Christopher L |e investigator |4 oth | |
| 700 | 1 | |a Shehata, Alexandre M |e investigator |4 oth | |
| 700 | 1 | |a Cohen, Zaza |e investigator |4 oth | |
| 700 | 1 | |a Allusson, Valerie |e investigator |4 oth | |
| 700 | 1 | |a Bambrick-Santoyo, Gabriela |e investigator |4 oth | |
| 700 | 1 | |a Aain Bhatti, Noor Ul |e investigator |4 oth | |
| 700 | 1 | |a Mehta, Bijal |e investigator |4 oth | |
| 700 | 1 | |a Williams, Aquino |e investigator |4 oth | |
| 700 | 1 | |a Brenner, Samantha K |e investigator |4 oth | |
| 700 | 1 | |a Walters, Patricia |e investigator |4 oth | |
| 700 | 1 | |a Go, Ronaldo C |e investigator |4 oth | |
| 700 | 1 | |a Rose, Keith M |e investigator |4 oth | |
| 700 | 1 | |a Hernán, Miguel A |e investigator |4 oth | |
| 700 | 1 | |a Zhou, Amy M |e investigator |4 oth | |
| 700 | 1 | |a Kim, Ethan C |e investigator |4 oth | |
| 700 | 1 | |a Lisk, Rebecca |e investigator |4 oth | |
| 700 | 1 | |a Chan, Lili |e investigator |4 oth | |
| 700 | 1 | |a Mathews, Kusum S |e investigator |4 oth | |
| 700 | 1 | |a Coca, Steven G |e investigator |4 oth | |
| 700 | 1 | |a Altman, Deena R |e investigator |4 oth | |
| 700 | 1 | |a Saha, Aparna |e investigator |4 oth | |
| 700 | 1 | |a Soh, Howard |e investigator |4 oth | |
| 700 | 1 | |a Wen, Huei Hsun |e investigator |4 oth | |
| 700 | 1 | |a Bose, Sonali |e investigator |4 oth | |
| 700 | 1 | |a Leven, Emily A |e investigator |4 oth | |
| 700 | 1 | |a Wang, Jing G |e investigator |4 oth | |
| 700 | 1 | |a Mosoyan, Gohar |e investigator |4 oth | |
| 700 | 1 | |a Pattharanitima, Pattharawin |e investigator |4 oth | |
| 700 | 1 | |a Gallagher, Emily J |e investigator |4 oth | |
| 700 | 1 | |a Friedman, Allon N |e investigator |4 oth | |
| 700 | 1 | |a Guirguis, John |e investigator |4 oth | |
| 700 | 1 | |a Kapoor, Rajat |e investigator |4 oth | |
| 700 | 1 | |a Meshberger, Christopher |e investigator |4 oth | |
| 700 | 1 | |a Kelly, Katherine J |e investigator |4 oth | |
| 700 | 1 | |a Parikh, Chirag R |e investigator |4 oth | |
| 700 | 1 | |a Garibaldi, Brian T |e investigator |4 oth | |
| 700 | 1 | |a Corona-Villalobos, Celia P |e investigator |4 oth | |
| 700 | 1 | |a Wen, Yumeng |e investigator |4 oth | |
| 700 | 1 | |a Menez, Steven |e investigator |4 oth | |
| 700 | 1 | |a Malik, Rubab F |e investigator |4 oth | |
| 700 | 1 | |a Cervantes, Carmen Elena |e investigator |4 oth | |
| 700 | 1 | |a Gautam, Samir C |e investigator |4 oth | |
| 700 | 1 | |a Mallappallil, Mary C |e investigator |4 oth | |
| 700 | 1 | |a Ouyang, Jie |e investigator |4 oth | |
| 700 | 1 | |a John, Sabu |e investigator |4 oth | |
| 700 | 1 | |a Yap, Ernie |e investigator |4 oth | |
| 700 | 1 | |a Melaku, Yohannes |e investigator |4 oth | |
| 700 | 1 | |a Mohamed, Ibrahim |e investigator |4 oth | |
| 700 | 1 | |a Bajracharya, Siddhartha |e investigator |4 oth | |
| 700 | 1 | |a Puri, Isha |e investigator |4 oth | |
| 700 | 1 | |a Thaxton, Mariah |e investigator |4 oth | |
| 700 | 1 | |a Bhattacharya, Jyotsna |e investigator |4 oth | |
| 700 | 1 | |a Wagner, John |e investigator |4 oth | |
| 700 | 1 | |a Boudourakis, Leon |e investigator |4 oth | |
| 700 | 1 | |a Nguyen, H Bryant |e investigator |4 oth | |
| 700 | 1 | |a Ahoubim, Afshin |e investigator |4 oth | |
| 700 | 1 | |a Thomas, Leslie F |e investigator |4 oth | |
| 700 | 1 | |a Sirganagari, Dheeraj Reddy |e investigator |4 oth | |
| 700 | 1 | |a Guru, Pramod K |e investigator |4 oth | |
| 700 | 1 | |a Zhou, Yan |e investigator |4 oth | |
| 700 | 1 | |a Bergl, Paul A |e investigator |4 oth | |
| 700 | 1 | |a Rodriguez, Jesus |e investigator |4 oth | |
| 700 | 1 | |a Shah, Jatan A |e investigator |4 oth | |
| 700 | 1 | |a Gupta, Mrigank S |e investigator |4 oth | |
| 700 | 1 | |a Kumar, Princy N |e investigator |4 oth | |
| 700 | 1 | |a Lazarous, Deepa G |e investigator |4 oth | |
| 700 | 1 | |a Kassaye, Seble G |e investigator |4 oth | |
| 700 | 1 | |a Melamed, Michal L |e investigator |4 oth | |
| 700 | 1 | |a Johns, Tanya S |e investigator |4 oth | |
| 700 | 1 | |a Mocerino, Ryan |e investigator |4 oth | |
| 700 | 1 | |a Prudhvi, Kalyan |e investigator |4 oth | |
| 700 | 1 | |a Zhu, Denzel |e investigator |4 oth | |
| 700 | 1 | |a Levy, Rebecca V |e investigator |4 oth | |
| 700 | 1 | |a Azzi, Yorg |e investigator |4 oth | |
| 700 | 1 | |a Fisher, Molly |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of internal medicine |d 1945 |g 174(2021), 5 vom: 25. Mai, Seite 622-632 |w (DE-627)NLM000012777 |x 1539-3704 |7 nnns |
| 773 | 1 | 8 | |g volume:174 |g year:2021 |g number:5 |g day:25 |g month:05 |g pages:622-632 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.7326/M20-6739 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 174 |j 2021 |e 5 |b 25 |c 05 |h 622-632 | ||