Effects of Standard-Dose Prophylactic, High-Dose Prophylactic, and Therapeutic Anticoagulation in Patients With Hypoxemic COVID-19 Pneumonia
In: ISSN: 2168-6106, 2023
academicJournal
Zugriff:
International audience ; Importance Given the high risk of thrombosis and anticoagulation-related bleeding in patients with hypoxemic COVID-19 pneumonia, identifying the lowest effective dose of anticoagulation therapy for these patients is imperative. Objectives To determine whether therapeutic anticoagulation (TA) or high-dose prophylactic anticoagulation (HD-PA) decreases mortality and/or disease duration compared with standard-dose prophylactic anticoagulation (SD-PA), and whether TA outperforms HD-PA; and to compare the net clinical outcomes among the 3 strategies. Design, Settings, and Participants The ANTICOVID randomized clinical open-label trial included patients with hypoxemic COVID-19 pneumonia requiring supplemental oxygen and having no initial thrombosis on chest computer tomography with pulmonary angiogram at 23 health centers in France from April 14 to December 13, 2021. Of 339 patients randomized, 334 were included in the primary analysis—114 patients in the SD-PA group, 110 in the HD-PA, and 110 in the TA. At randomization, 90% of the patients were in the intensive care unit. Data analyses were performed from April 13, 2022, to January 3, 2023. Interventions Patients were randomly assigned (1:1:1) to receive either SD-PA, HD-PA, or TA with low-molecular-weight or unfractionated heparin for 14 days. Main Outcomes and Measures A hierarchical criterion of all-cause mortality followed by time to clinical improvement at day 28. Main secondary outcome was net clinical outcome at day 28 (composite of thrombosis, major bleeding, and all-cause death). Results Among the study population of 334 individuals (mean [SD] age, 58.3 [13.0] years; 226 [67.7%] men and 108 [32.3%] women), use of HD-PA and SD-PA had similar probabilities of favorable outcome (47.3% [95% CI, 39.9% to 54.8%] vs 52.7% [95% CI, 45.2% to 60.1%]; P = .48), as did TA compared with SD-PA (50.9% [95% CI, 43.4% to 58.3%] vs 49.1% [95% CI, 41.7% to 56.6%]; P = .82) and TA compared with HD-PA (53.5% [95% CI 45.8% to 60.9%] vs 46.5% [95% CI, ...
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Effects of Standard-Dose Prophylactic, High-Dose Prophylactic, and Therapeutic Anticoagulation in Patients With Hypoxemic COVID-19 Pneumonia
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Autor/in / Beteiligte Person: | Labbé, Vincent ; Contou, Damien ; Heming, Nicholas ; Megarbane, Bruno ; Razazi, Keyvan ; Boissier, Florence ; Ait-Oufella, Hafid ; Turpin, Matthieu ; Carreira, Serge ; Robert, Alexandre ; Monchi, Mehran ; Souweine, Bertrand ; Preau, Sebastien ; Doyen, Denis ; Vivier, Emmanuel ; Zucman, Noémie ; Dres, Martin ; Fejjal, Mohamed ; Noel-Savina, Elise ; Bachir, Marwa ; Jaffal, Karim ; Timsit, Jean-François ; Picos, Santiago Alberto ; Mariotte, Eric ; Martis, Nihal ; Juguet, William ; Melica, Giovanna ; Rondeau, Paul ; Audureau, Etienne ; Mekontso Dessap, Armand ; Plantefevre, Gaetan ; Annane, Djillali ; Dinh, Aurélien ; Abdeladim, Lilia ; Bounab, Rania ; Moine, Pierre ; Maxime, Virginie ; Tessa, Hayette ; Carlos, Miguel ; Kuperminc, Emmanuelle ; Voicu, Sebastian ; Malissin, Isabelle ; Deye, Nicolas ; M'Rad, Aymen ; Lacoste-Palasset, Thomas ; Lefevre, Thomas ; Haudebourg, Luc ; Ekhérian, Jean-Michel ; Bagate, François ; de Prost, Nicolas ; Carteaux, Guillaume ; Bendib, Inès ; Tuffet, Samuel ; Lopinto, Julien ; Labedade, Pascale ; Michaud, Gaêl ; Benelli, Brice ; Haudebourg, Anne Fleur ; Gendreau, Ségolène ; Berti, Enora ; Bertier, Astrid ; Arrestier, Romain ; Masi, Paul ; Dufranc, Etienne ; Coudroy, Remi ; Thille, Arnaud ; Veinstein, Anne ; Chatellier, Delphine ; Frat, Jean-Pierre ; Rodriguez, Maeva ; Reynaud, Faustine ; de Roubin, Victor ; Arrive, François ; Gabarre, Paul ; Bollens, Diane ; Ingiliz, Patrick ; Lefebvre, Benedicte ; Ouazene, Zineb ; Chiarabini, Thibault ; Valin, Nadia ; Urbina, Tomas ; Bonny, Vincent ; Bige, Naike ; Lacombe, Karine ; Fartoukh, Muriel ; Desnos, Cyrielle ; Voiriot, Guillaume ; Djibré, Michel ; Blayau, Clarisse ; Gibelin, Aude ; Dessajan, Julien ; Lassel, Ludovic ; Bertrand, Pierre-Marie ; Chambon, Raphael ; Clément, Nicolas ; Sy, Oumar ; Jochmans, Sebastien ; Dupuis, Claire ; Calvet, Laure ; Thouy, François ; Grapin, Kevin ; Laurichesse, Guillaume ; Kinda, Frederic ; Couhault, Pierre ; Dopeux, Loïc ; Goutay, Julien ; Ledoux, Geoffrey ; Tortuyaux, Romain ; Gaudet, Alexandre ; Rouze, Anahita ; Moreau, Anne-Sophie ; Girardi, Patrick ; Jourdain, Mercedes ; Poissy, Julien ; Favory, Raphael ; Nseir, Saadala ; Buscot, Matthieu ; Dellamonica, Jean ; Saccheri, Clément ; Demonchy, Elisa ; Chirio, David ; Risso, Karine ; Taurel, Marina ; Bourdin, Gaël ; Donze, Pierre ; Pommier, Christian ; Rosselli, Sylvène ; Simonin, Marine ; Ricard, Jean-Damien ; Thiry, Ingrid ; Freita Ramos, Santiago ; Verney, Charles ; Uhel, Fabrice ; Priour, Isabelle ; Roux, Damien ; Beurton, Alexandra ; Bureau, Côme ; Déléris, Robin ; Mayaux, Julien ; Le Marec, Julien ; Nemlaghi, Safaa ; Clerc, Sébastien ; Demoule, Aleandre ; Morawiec, Elise ; Picard, Benjamin ; Pichon, Jérémie ; Chafiotte, Pierre ; Menat, Sophie ; Pontier, Sandrine ; Legenne, Frédérique ; Bouadma, Lila ; Abdel-Nabey, Moustafa ; Girard, Tiphaine ; Jaquet, Pierre ; Patrier, Juliette ; Presente, Simona ; Leroy, Julien ; Mechai, Frederic ; Cordel, Hugues ; Hassold-Rugolino, Nolan ; Emery, Malo ; Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S 1144 / U1144)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité) ; Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE) ; Institut Pasteur de Lille ; Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille) ; Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord |
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Zeitschrift: | ISSN: 2168-6106, 2023 |
Veröffentlichung: | HAL CCSD ; American Medical Association, 2023 |
Medientyp: | academicJournal |
DOI: | 10.1001/jamainternmed.2023.0456 |
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