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Title: | Impact of implementation of an individualised thromboprophylaxis protocol in critically ill ICU patients with COVID-19: A longitudinal controlled before-after study | Authors: | STESSEL, Bjorn Vancuchelen, Charlotte BRUCKERS, Liesbeth Geebelen, Laurien CALLEBAUT, Ina VANDENBRANDE, Jeroen Pallens, Ben Van Tornout, Michiel Ory, Jean-Paul van Halem, Karlijn MESSIAEN, Peter HERBOTS, Lieven Ramaekers, Dirk Dubois, Jasperina |
Issue Date: | 2020 | Publisher: | PERGAMON-ELSEVIER SCIENCE LTD | Source: | THROMBOSIS RESEARCH, 194 , p. 209 -215 | Abstract: | Introduction: An individualised thromboprophylaxis was implemented in critically ill patients suffering from coronavirus disease 2019 (COVID-19) pneumonia to reduce mortality and improve clinical outcome. The aim of this study was to evaluate the effect of this intervention on clinical outcome. Methods: In this mono-centric, controlled, before-after study, all consecutive adult patients with confirmed COVID-19 pneumonia admitted to ICU from March 13th to April 20th 2020 were included. A thromboprophylaxis protocol, including augmented LMWH dosing, individually tailored with anti-Xa measurements and twice-weekly ultrasonography screening for DVT, was implemented on March 31th 2020. Primary endpoint is one-month mortality. Secondary outcomes include two-week and three-week mortality, the incidence of VTE, acute kidney injury and continuous renal replacement therapy (CRRT). Multiple regression modelling was used to correct for differences between the two groups. Results: 46 patients were included in the before group, 26 patients in the after group. One month mortality decreased from 39.13% to 3.85% (p < 0.001). After correction for confounding variables, one-month mortality was significantly higher in the before group (p = 0.02, OR 8.86 (1.46, 53.75)). The cumulative incidence of VTE and CRRT was respectively 41% and 30.4% in the before group and dropped to 15% (p = 0.03) and 3.8% (p = 0.01), respectively. After correction for confounding variables, risk of VTE (p = 0.03, 6.01 (1.13, 32.12)) and CRRT (p = 0.02, OR 19.21 (1.44, 255.86)) remained significantly higher in the before group. Conclusion: Mortality, cumulative risk of VTE and need for CRRT may be significantly reduced in COVID-19 patients by implementation of a more aggressive thromboprophylaxis protocol. Future research should focus on confirmation of these results in a randomized design and on uncovering the mechanisms underlying these observations. . | Notes: | Stessel, B (corresponding author), Jessa Hosp Hasselt, Dept Intens Care & Anesthesiol, Virga Jesse Campus,Stadsomvaart 11, B-3500 Hasselt, Belgium. bjorn.stessel@jessazh.be |
Other: | Stessel, B (corresponding author), Jessa Hosp Hasselt, Dept Intens Care & Anesthesiol, Virga Jesse Campus,Stadsomvaart 11, B-3500 Hasselt, Belgium. bjorn.stessel@jessazh.be | Keywords: | COVID-19;Thromboprophylaxis;Venous thromboembolism;Mortality;Continuous renal replacement therapy | Document URI: | http://hdl.handle.net/1942/32901 | ISSN: | 0049-3848 | e-ISSN: | 1879-2472 | DOI: | 10.1016/j.thromres.2020.07.038 | ISI #: | WOS:000568490100037 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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1-s2.0-S0049384820303297-main.pdf | Published version | 558.17 kB | Adobe PDF | View/Open |
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