.jpg "Kelsey Dobbins, BCCCP, BCPS photo")
Kelsey Dobbins, BCCCP, BCPS
Clinical Pharmacist
WakeMed Health & Hospital
Garner, North Carolina
Disclosure information not submitted.
Daniel Fox, MD
Director, Physician Intensivists
WakeMed Health & Hospitals, United States
Disclosure information not submitted.
Amanda Edwards, PA-C
Director, Advanced Practice Providers
WakeMed Health & Hospitals, United States
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Mollie Grant, PharmD, BCCCP
Mollie Grant
WakeMed Health and Hospitals, United States
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Cristina Gurganious, PharmD, BCPS, BCCCP
Clinical Pharmacist
WakeMed Health & Hospitals, United States
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David Kirk, MD
Associate chief medical officer
WakeMed, United States
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Jessica Ledford, BCCCP, BCPS, PharmD
J. Erin Ledford
WakeMed Health & Hospitals, United States
Disclosure information not submitted.
Title: Incidence of Thrombotic Events With Different Antithrombotic Strategies in Patients With COVID-19
Introduction/Hypothesis: Thrombotic complications occur frequently in patients infected with coronavirus disease 2019 (COVID-19) despite the use of standard prophylactic doses of anticoagulants. Several studies have compared different antithrombotic regimens in patients with COVID-19 but have not demonstrated a consistent benefit with higher doses of anticoagulants for thromboprophylaxis or empiric anticoagulation. To date, our institution has treated over 1000 COVID-19 patients using a standardized thromboprophylaxis regimen unless the patient had a compelling reason for therapeutic anticoagulation.
Methods: A retrospective analysis of adult patients admitted to our institution with COVID-19 between 3/1/2020 and 9/30/2020 was performed. Patients were divided into three groups based on the thromboprophylaxis dosing strategy utilized during admission: standard prophylactic dosing, augmented dosing, or therapeutic dosing. The primary endpoint was incidence of thrombotic events. Secondary endpoints included incidence of bleeding events, in-hospital mortality, and need for new renal replacement therapy.
Results: After screening for exclusion criteria, 682 patients were included in the final analysis. Patients in the augmented dosing group experienced more thrombotic events than patients who received standard prophylactic dosing (20.7% vs 4.5%, p< 0.001). Both therapeutic and augmented dosing were associated with a higher incidence of any bleeding event compared with standard prophylactic dosing (19.8% vs 4.7%, p< 0.001 and 17.2% vs 4.7%, p< 0.011, respectively). Patients in the therapeutic dosing group were more likely to experience a major bleeding event based on the International Society on Thrombosis and Haemostasis criteria than patients who received prophylactic dosing (5.2% vs 0.7%, p=0.014). In-hospital mortality was higher with therapeutic and augmented dosing compared to standard prophylactic dosing (19.8% vs 11.0%, p=0.023 and 27.6% vs 11.0%, p=0.016, respectively). More patients in the therapeutic and augmented dosing groups required initiation of renal replacement therapy.
Conclusions: Therapeutic and augmented dosing strategies for thromboprophylaxis did not reduce the incidence of thrombotic events in patients with COVID-19. Higher doses of anticoagulants may be associated with worse clinical outcomes.