Tran Minh-Hoang, Nguyen Hoang Hai, Nguyen Quang Trung, Tran Thy Doan Minh, Truong-Nguyen Kim-Huong, Pham Hong Tham
Therapeutics, NTT Hi-Tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, VNM.
Cardiology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM.
Cureus. 2024 Aug 19;16(8):e67256. doi: 10.7759/cureus.67256. eCollection 2024 Aug.
Step-based dosing of anticoagulants has been widely implemented for the treatment of coronavirus disease 2019 (COVID-19), but no studies have comprehensively evaluated the effectiveness and safety of this approach. We aimed to investigate whether step-based dosing of anticoagulants was associated with clinical outcomes in patients with COVID-19 compared with standard prophylactic dosing.
We conducted a retrospective cohort study on adults hospitalized with moderate-to-severe COVID-19. The exposure was step-based dosing of anticoagulants, including prophylactic anticoagulants (PrA), prophylactic-switching-to-therapeutic anticoagulants (Pr-to-ThA), therapeutic anticoagulants (ThA), and therapeutic-switching-to-prophylactic anticoagulants (Th-to-PrA). The primary effectiveness outcome was a composite of all-cause mortality, admission to an intensive care unit (ICU admission), stroke, and venous thromboembolism (VTE). The primary safety outcome was a composite of major and minor/clinically relevant non-major (CRNM) bleeding.
Among 1,081 records for analysis (mean age 59.9, 49.9% being female), during a median follow-up of 15 days, the primary effectiveness outcome occurred in 333 patients (33.5% in the PrA group, 24.6% in the Pr-to-ThA group, 23.7% in the Th-to-PrA group, and 38.0% in the ThA group). Compared with the PrA group, patients receiving Pr-to-ThA had a lower risk of the primary effectiveness outcome (adjusted odds ratio (OR) 0.64, 95% CI: 0.45 to 0.90, Dunnett-adjusted p = 0.01), while those in the Th-to-PrA and ThA were more likely to experience the primary safety outcome (Th-to-PrA, aOR = 3.00, 95% CI: 1.53 to 5.89; ThA, aOR = 3.05, 95% CI: 1.61 to 5.79).
In adults hospitalized with moderate-to-severe COVID-19, compared with standard PrA, the step-based dose-increasing therapy was associated with a lower composite risk of all-cause mortality, ICU admission, stroke, or VTE without evidence of a higher risk of bleeding. ThA dosing was associated with an increase in the bleeding risk, primarily minor and CRNM bleeding.
基于阶段的抗凝药物给药方案已广泛应用于2019冠状病毒病（COVID-19）的治疗，但尚无研究全面评估该方法的有效性和安全性。我们旨在研究与标准预防性给药相比，基于阶段的抗凝药物给药方案是否与COVID-19患者的临床结局相关。
我们对中度至重度COVID-19住院成人进行了一项回顾性队列研究。暴露因素为基于阶段的抗凝药物给药，包括预防性抗凝（PrA）、预防性转换为治疗性抗凝（Pr-to-ThA）、治疗性抗凝（ThA）以及治疗性转换为预防性抗凝（Th-to-PrA）。主要有效性结局为全因死亡率、入住重症监护病房（ICU入住）、中风和静脉血栓栓塞（VTE）的综合结果。主要安全性结局为大出血和轻微/临床相关非大出血（CRNM）的综合结果。
在1081份可供分析的记录中（平均年龄59.9岁，女性占49.9%），中位随访15天时，333例患者出现了主要有效性结局（PrA组为33.5%，Pr-to-ThA组为24.6%，Th-to-PrA组为23.7%，ThA组为38.0%）。与PrA组相比，接受Pr-to-ThA的患者出现主要有效性结局的风险较低（调整后的优势比（OR）为0.64，95%置信区间：0.45至0.90，Dunnett校正p = 0.01），而Th-to-PrA组和ThA组的患者更有可能出现主要安全性结局（Th-to-PrA，调整后的OR = 3.00，95%置信区间：1.53至5.89；ThA，调整后的OR = 3.05，95%置信区间：1.61至5.79）。
在中度至重度COVID-19住院成人中，与标准PrA相比，基于阶段的剂量增加疗法与全因死亡率、ICU入住、中风或VTE的综合风险较低相关，且无出血风险升高的证据。ThA给药与出血风险增加相关，主要是轻微出血和CRNM出血。
