PMID- 34013153
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230328
IS  - 2475-0379 (Electronic)
IS  - 2475-0379 (Linking)
VI  - 5
IP  - 4
DP  - 2021 May
TI  - Management of therapeutic unfractionated heparin in COVID-19 patients: A 
      retrospective cohort study.
PG  - e12521
LID - 10.1002/rth2.12521 [doi]
LID - e12521
AB  - BACKGROUND: Patients hospitalized with severe acute respiratory syndrome 
      coronavirus 2 infection are at risk for thrombotic complications necessitating 
      use of therapeutic unfractionated heparin (UFH). Full-dose anticoagulation limits 
      requirements for organ support interventions in moderately ill patients with 
      coronavirus disease 2019 (COVID-19). Given this benefit, it is important to 
      evaluate response to therapeutic anticoagulation in this population. OBJECTIVES: 
      The aim of this study was to assess therapeutic UFH infusions and associated 
      bleeding risk in patients with COVID-19. PATIENTS/METHODS: This retrospective 
      cohort study includes patients at Brigham and Women's Hospital, Boston, 
      Massachusetts, receiving weight-based nursing-nomogram titrated UFH infusion 
      during a 10-week surge in COVID-19 hospitalizations. Of 358 patients on 
      therapeutic UFH during this interval, 97 (27.1%) had confirmed COVID-19. Patient 
      characteristics, laboratory values, and information regarding UFH infusion and 
      bleeding events were obtained from the electronic medical record. RESULTS: 
      Patients who were COVID-19 positive had fewer therapeutic activatrd partial 
      thromboplastin times (aPTTs) compared to COVID-19-negative patients (median rate, 
      40.0% vs 53.1%; P < .0005). Both major and clinically relevant nonmajor bleeding 
      were increased in COVID-19-positive patients, with major bleeding observed in 
      10.3% (95% confidence interval [CI], 5.7%-17.9%) of patients who were COVID-19 
      positive and 3.1% (95% CI, 1.6%-5.9%) of patients who were COVID-19 negative 
      (P < .005). In logistic regression, bleeding events were associated with 
      receiving UFH for longer than 7 days, but not platelet count, coagulation, or 
      inflammatory measurements. CONCLUSIONS: Our data indicate a higher incidence of 
      bleeding complications in patients with COVID-19 receiving weight-based 
      nursing-nomogram titrated UFH infusions despite a higher prevalence of 
      subtherapeutic aPTTs in this population. These data underscore the need for 
      prospective studies aimed at improving the quality and safety of therapeutic 
      anticoagulation in patients with COVID-19.
CI  - (c) 2021 The Authors. Research and Practice in Thrombosis and Haemostasis published 
      by Wiley Periodicals LLC on behalf of International Society on Thrombosis and 
      Haemostasis (ISTH).
FAU - Weeks, Lachelle D
AU  - Weeks LD
AUID- ORCID: 0000-0001-8726-6212
AD  - Department of Medical Oncology Dana Farber Cancer Institute Boston MA USA.
AD  - Harvard Medical School Boston MA USA.
FAU - Sylvester, Katelyn W
AU  - Sylvester KW
AUID- ORCID: 0000-0001-9208-2354
AD  - Department of Pharmacy Services Brigham and Women's Hospital Boston MA USA.
FAU - Connors, Jean M
AU  - Connors JM
AUID- ORCID: 0000-0001-6445-582X
AD  - Harvard Medical School Boston MA USA.
AD  - Hematology Division, Department of Medicine Brigham and Women's Hospital Boston 
      MA USA.
FAU - Connell, Nathan T
AU  - Connell NT
AUID- ORCID: 0000-0003-4100-7826
AD  - Harvard Medical School Boston MA USA.
AD  - Hematology Division, Department of Medicine Brigham and Women's Hospital Boston 
      MA USA.
LA  - eng
GR  - T32 HL116324/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20210507
PL  - United States
TA  - Res Pract Thromb Haemost
JT  - Research and practice in thrombosis and haemostasis
JID - 101703775
PMC - PMC8114028
OTO - NOTNLM
OT  - COVID-19
OT  - SARS-CoV-2
OT  - bleeding
OT  - coronavirus
OT  - coronavirus 2019
OT  - therapeutic anticoagulation
OT  - thromboembolism
OT  - thrombosis
OT  - unfractionated heparin
EDAT- 2021/05/21 06:00
MHDA- 2021/05/21 06:01
PMCR- 2021/05/07
CRDT- 2021/05/20 06:48
PHST- 2020/12/31 00:00 [received]
PHST- 2021/02/23 00:00 [revised]
PHST- 2021/03/30 00:00 [accepted]
PHST- 2021/05/20 06:48 [entrez]
PHST- 2021/05/21 06:00 [pubmed]
PHST- 2021/05/21 06:01 [medline]
PHST- 2021/05/07 00:00 [pmc-release]
AID - S2475-0379(22)01389-9 [pii]
AID - RTH212521 [pii]
AID - 10.1002/rth2.12521 [doi]
PST - epublish
SO  - Res Pract Thromb Haemost. 2021 May 7;5(4):e12521. doi: 10.1002/rth2.12521. 
      eCollection 2021 May.