PMID- 35716998
OWN - NLM
STAT- MEDLINE
DCOM- 20220817
LR  - 20220928
IS  - 2213-3348 (Electronic)
IS  - 2213-333X (Print)
VI  - 10
IP  - 5
DP  - 2022 Sep
TI  - Low-molecular-weight heparin compared with unfractionated heparin in critically 
      ill COVID-19 patients.
PG  - 1128-1136
LID - S2213-333X(22)00260-8 [pii]
LID - 10.1016/j.jvsv.2022.04.019 [doi]
AB  - BACKGROUND: Thrombosis in COVID-19 worsens mortality. In our study, we sought to 
      investigate how the dose and type of anticoagulation (AC) can influence patient 
      outcomes. METHODS: This is a single-center retrospective analysis of critically 
      ill intubated patients with COVID-19, comparing low-molecular-weight heparin 
      (LMWH) and unfractionated heparin (UFH) at therapeutic and prophylactic doses. Of 
      218 patients, 135 received LMWH (70 prophylactic, 65 therapeutic) and 83 UFH (11 
      prophylactic, 72 therapeutic). The primary outcome was mortality. Secondary 
      outcomes were thromboembolic complications confirmed on imaging and major 
      bleeding complications. Cox proportional-hazards regression models were used to 
      determine whether the type and dose of AC were independent predictors of 
      survival. We performed Kaplan-Meier survival analysis to compare the cumulative 
      survivals. RESULTS: Overall, therapeutic AC, with either LMWH (65% vs 79%, P = 
      .09) or UFH (32% vs 46%, P = .73), conveyed no survival benefit over prophylactic 
      AC. UFH was associated with a higher mortality rate than LMWH (66% vs 28%, P = 
      .001), which was also evident in the multivariable analysis (LMWH vs UFH 
      mortality, hazard ratio: 0.47, P = .001) and in the Kaplan-Meier survival 
      analysis. Thrombotic and bleeding complications did not depend on the AC type 
      (prophylactic LMWH vs UFH: thrombosis P = .49, bleeding P = .075; therapeutic 
      LMWH vs UFH: thrombosis P = .5, bleeding P = .17). When comparing prophylactic 
      with therapeutic AC, the rate of both thrombotic and bleeding complications was 
      higher with the use of LMWH compared with UFH. In addition, transfusion 
      requirements were significantly higher with both therapeutic LMWH and UFH. 
      CONCLUSIONS: Among intubated critically ill COVID-19 intensive care unit 
      patients, therapeutic AC, with either LMWH or UFH, conveyed no survival benefit 
      over prophylactic AC. AC with LMWH was associated with higher cumulative survival 
      compared with AC with UFH.
CI  - Published by Elsevier Inc.
FAU - Volteas, Panagiotis
AU  - Volteas P
AD  - Department of Surgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Drakos, Panagiotis
AU  - Drakos P
AD  - Department of Surgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Alkadaa, Leor N
AU  - Alkadaa LN
AD  - Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Cleri, Nathaniel A
AU  - Cleri NA
AD  - Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Asencio, Anthony A
AU  - Asencio AA
AD  - Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Oganov, Anthony
AU  - Oganov A
AD  - Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Giannopoulos, Stefanos
AU  - Giannopoulos S
AD  - Department of Surgery, Renaissance School of Medicine, Stony Brook, NY; Division 
      of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony 
      Brook, NY.
FAU - Saadon, Jordan R
AU  - Saadon JR
AD  - Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Mikell, Charles B 3rd
AU  - Mikell CB 3rd
AD  - Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Rubano, Jerry A
AU  - Rubano JA
AD  - Department of Surgery, Renaissance School of Medicine, Stony Brook, NY.
FAU - Labropoulos, Nicos
AU  - Labropoulos N
AD  - Division of Vascular Surgery, Department of Surgery, Renaissance School of 
      Medicine, Stony Brook, NY.
FAU - Tassiopoulos, Apostolos K
AU  - Tassiopoulos AK
AD  - Department of Surgery, Renaissance School of Medicine, Stony Brook, NY; Division 
      of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony 
      Brook, NY.
FAU - Mofakham, Sima
AU  - Mofakham S
AD  - Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY. 
      Electronic address: sima.mofakham@stonybrookmedicine.edu.
FAU - Bannazadeh, Mohsen
AU  - Bannazadeh M
AD  - Department of Surgery, Renaissance School of Medicine, Stony Brook, NY; Division 
      of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony 
      Brook, NY.
LA  - eng
PT  - Journal Article
DEP - 20220615
PL  - United States
TA  - J Vasc Surg Venous Lymphat Disord
JT  - Journal of vascular surgery. Venous and lymphatic disorders
JID - 101607771
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - *COVID-19/complications
MH  - Critical Illness
MH  - Heparin/adverse effects
MH  - Heparin, Low-Molecular-Weight/adverse effects
MH  - Humans
MH  - Retrospective Studies
MH  - *Thrombosis/diagnostic imaging/etiology/prevention & control
PMC - PMC9212478
OTO - NOTNLM
OT  - Anticoagulation (AC)
OT  - COVID-19
OT  - Low-molecular-weight heparin (LMWH)
OT  - SARS-CoV-2
OT  - Thromboprophylaxis
OT  - Unfractionated heparin (UFH)
EDAT- 2022/06/19 06:00
MHDA- 2022/08/18 06:00
PMCR- 2022/06/15
CRDT- 2022/06/18 19:37
PHST- 2022/01/07 00:00 [received]
PHST- 2022/04/05 00:00 [revised]
PHST- 2022/04/26 00:00 [accepted]
PHST- 2022/06/19 06:00 [pubmed]
PHST- 2022/08/18 06:00 [medline]
PHST- 2022/06/18 19:37 [entrez]
PHST- 2022/06/15 00:00 [pmc-release]
AID - S2213-333X(22)00260-8 [pii]
AID - 10.1016/j.jvsv.2022.04.019 [doi]
PST - ppublish
SO  - J Vasc Surg Venous Lymphat Disord. 2022 Sep;10(5):1128-1136. doi: 
      10.1016/j.jvsv.2022.04.019. Epub 2022 Jun 15.