A Multicenter Study Assessing the Optimal Anticoagulation Strategies in COVID-19 Critically Ill Patients with New-Onset Atrial Fibrillation: Balancing Effectiveness and Safety.
Khalid Al Sulaiman, Ohoud Aljuhani, Ghazwa B Korayem, Ali F Altebainawi, Aisha Alharbi, Mai Alalawi, Hala Joharji, Rand Abdullah Almohsen, Rawa M Faden, Nada Alotaibi, Bdour S Alshalawi, Nasser Alkhushaym, Fai F Alanazi, Ashwaq Alharbi, Aisha Alqarni, Shahad Samkari, Bader Alharbi, Nura Alshehab, Rawan A Alshehri, Ramesh Vishwakarma
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引用次数: 0
Abstract
Purpose: 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.
Methods: 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.
Results: 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; P=0.65 and OR 2.04; 95% CI 0.17, 24.3; P=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; P=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, P=0.03).
Conclusion: 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.
目的：评价新冠肺炎危重患者新发心房颤动（Afib）重症监护病房（ICU）期间抗凝治疗方案的有效性和安全性。方法：采用多中心、回顾性队列研究，纳入重症监护室收治的COVID-19危重患者。新发Afib患者根据抗凝剂量分为两组（预防与治疗）。主要观察指标为出血率；其他结果被认为是次要的。PS匹配后酌情采用Logistic回归、负二项回归和Cox比例风险回归分析。结果：共有107例患者符合条件。经PS匹配（1:1比例）后，56例患者纳入最终分析。在接受抗凝治疗剂量的患者中，大出血和小出血的发生率较高；但未达到统计学显著性(OR 1.46；95% ci 0.29, 7.42；P=0.65, OR 2.04；95% ci 0.17, 24.3；分别为P = 0.57)。两组住院时间和住院死亡率差异无统计学意义(β系数-0.00；Ci -0.38, 0.37；P=0.99, HR 1.12, 95% CI 0.58-2.14；P = 0.74)。另一方面，治疗组患者的红细胞输血需求显著高于接受预防剂量的患者(β系数1.17；95% ci 0.11, 2.22, p =0.03)。结论：新发Afib重症患者使用治疗性抗凝剂量并不优于预防性抗凝剂量；然而，接受抗凝治疗剂量的患者有更高的红细胞输血需求。我们的结果必须谨慎；因此，需要更大样本量的随机介入研究来证实我们的发现。
期刊介绍：
The International Journal of General Medicine is an international, peer-reviewed, open access journal that focuses on general and internal medicine, pathogenesis, epidemiology, diagnosis, monitoring and treatment protocols. The journal is characterized by the rapid reporting of reviews, original research and clinical studies across all disease areas.
A key focus of the journal is the elucidation of disease processes and management protocols resulting in improved outcomes for the patient. Patient perspectives such as satisfaction, quality of life, health literacy and communication and their role in developing new healthcare programs and optimizing clinical outcomes are major areas of interest for the journal.
As of 1st April 2019, the International Journal of General Medicine will no longer consider meta-analyses for publication.
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