Al Sulaiman Khalid, Aljuhani Ohoud, Korayem Ghazwa B, Altebainawi Ali F, Alharbi Aisha, Alalawi Mai, Joharji Hala, Almohsen Rand Abdullah, Faden Rawa M, Alotaibi Nada, Alshalawi Bdour S, Alkhushaym Nasser, Alanazi Fai F, Alharbi Ashwaq, Alqarni Aisha, Samkari Shahad, Alharbi Bader, Alshehab Nura, Alshehri Rawan A, Vishwakarma Ramesh
Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Int J Gen Med. 2024 Nov 28;17:5611-5622. doi: 10.2147/IJGM.S484472. eCollection 2024.
To evaluate the effectiveness and safety of anticoagulation regimens in COVID-19 critically ill patients with new-onset Atrial fibrillation (Afib) during their intensive care unit (ICU) stays.
A multicenter, retrospective cohort study included critically ill patients with COVID-19 admitted to the ICUs. Patients with new-onset Afib were categorized into two groups based on anticoagulation doses (Prophylaxis vs Treatment). The primary outcome was the bleeding rate; other outcomes were considered secondary. Logistic, negative binomial regression, and Cox proportional hazards regression analyses were applied as appropriate after PS matching.
A total of 107 patients were eligible. After PS matching (1:1 ratio), 56 patients were included in the final analysis. A higher odd for major and minor bleeding were observed in the patients who received treatment doses of anticoagulation; however, it did not reach the statistically significant (OR 1.46; 95% CI 0.29, 7.42; =0.65 and OR 2.04; 95% CI 0.17, 24.3; =0.57, respectively). The hospital length of stay and in-hospital mortality showed no differences between the two groups (beta coefficient -0.00; CI -0.38, 0.37; =0.99 and HR 1.12, 95% CI 0.58-2.14; p = 0.74, respectively). On the other hand, patients in the treatment group had a statistically significant higher requirement of RBCs transfusion than patients who received a prophylaxis dose (beta coefficient 1.17; 95% CI 0.11, 2.22, 0.03).
The use of treatment anticoagulation doses in COVID-19 critically ill patients with new-onset Afib did not show better effectiveness over prophylactic anticoagulation doses; however, patients who received treatment anticoagulation doses had higher RBCs transfusion requirements. Our results must be cautious; thus, larger randomized interventional studies with a larger sample size are required to confirm our findings.
评估新冠重症患者在重症监护病房（ICU）住院期间新发房颤（Afib）时抗凝方案的有效性和安全性。
一项多中心回顾性队列研究纳入了入住ICU的新冠重症患者。新发Afib患者根据抗凝剂量分为两组（预防性抗凝组与治疗性抗凝组）。主要结局是出血率；其他结局视为次要结局。倾向得分匹配（PS匹配）后，酌情应用逻辑回归、负二项回归和Cox比例风险回归分析。
共有107例患者符合条件。PS匹配（1:1比例）后，56例患者纳入最终分析。接受治疗剂量抗凝的患者发生大出血和小出血的几率更高；然而，未达到统计学显著性（分别为OR 1.46；95%CI 0.29，7.42；P=0.65和OR 2.04；95%CI 0.17，24.3；P=0.57）。两组患者的住院时间和院内死亡率无差异（β系数-0.00；CI -0.38，0.37；P=0.99和HR 1.12，95%CI 0.58 - 2.14；P = 0.74）。另一方面，治疗组患者红细胞输注需求在统计学上显著高于接受预防性抗凝剂量的患者（β系数1.17；95%CI 0.11，2.22；P = 0.03）。
新冠重症新发Afib患者使用治疗性抗凝剂量并不比预防性抗凝剂量更有效；然而，接受治疗性抗凝剂量的患者红细胞输注需求更高。我们的结果必须谨慎对待；因此，需要更大样本量的大型随机干预研究来证实我们的发现。
