COVID-19 중환자에서 예방적 항응고제 사용 및 출혈 관련 약물이상반응 발생 현황 보고
Prophylactic Anticoagulant Use and Adverse Events with Bleeding in Critically Ill COVID-19 Patients
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Background : A number of global clinical guidelines recommend prophylactic anticoagulation on patients admitted to hospitals with coronavirus disease-2019 (COVID-19). However, recommendation on specific dose is lacking, especially for the critically ill. The purpose of this study was to investigate the current usage of prophylactic anticoagulant and its adverse events with bleeding in critically ill COVID-19 patients admitted to nationally-designated wards at a general hospital in Korea. Clinical outcomes with respect to prophylactic anticoagulant dose were also compared. Methods : We reviewed critically-ill COVID-19 inpatients admitted to a nationally-designated intensive care unit from February 1st, 2020 to May 31st, 2021 and identified the type and dose of prophylactic anticoagulant (AC) administered. Patients were further grouped into standard-dose (standard prophylactic AC) and intermediate-to-therapeutic-dose (higher than standard prophylactic AC) prophylaxis. Data on patients’ baseline characteristics, length of hospitalization, mortality, bleeding, and deep vein thrombosis (DVT) were retrospectively collected and analyzed through bivariate statistical methods. Regression analyses were conducted, with statistically significant patient characteristics as confounding variables, to evaluate the correlation between mortality, bleeding, DVT, length of hospitalization, and prophylactic anticoagulant dose. Results : Of 93 critically-ill COVID-19 patients, 80 (86.0%) received prophylactic AC. Of those, 60 (75.0%) were administered standard AC and 20 (25.0%), higher than standard AC. Length of hospitalization (36.5 days[n=40] vs. 53.9 days[n=18], p=.012), and mortality (33.3% vs. 10.0%, p=.043) showed statistically significant differences between the two groups. Bleeding also occurred in 16 (26.7%) and 8 (40.0%) patients, respectively, but were not significant (p=.260). Mortality, bleeding, DVT, length of hospitalization and prophylactic anticoagulant dose showed no correlation when analyzed through multivariate logistic and multiple regression. Conclusion : No significant association was found between the prophylactic anticoagulant dose and the patients’ clinical outcomes or bleeding occurrence. Further research is needed to evaluate prescription patterns of prophylactic anticoagulants for critically-ill COVID-19 patients including other hospitals and the clinical outcomes with thorough monitoring upon use.
Abstract
Background : A number of global clinical guidelines recommend prophylactic anticoagulation on patients admitted to hospitals with coronavirus disease-2019 (COVID-19). However, recommendation on specific dose is lacking, especially for the critically ill. The purpose of this study was to investigate the current usage of prophylactic anticoagulant and its adverse events with bleeding in critically ill COVID-19 patients admitted to nationally-designated wards at a general hospital in Korea. Clinical outcomes with respect to prophylactic anticoagulant dose were also compared. Methods : We reviewed critically-ill COVID-19 inpatients admitted to a nationally-designated intensive care unit from February 1st, 2020 to May 31st, 2021 and identified the type and dose of prophylactic anticoagulant (AC) administered. Patients were further grouped into standard-dose (standard prophylactic AC) and intermediate-to-therapeutic-dose (higher than standard prophylactic AC) prophylaxis. Data on patients’ baseline characteristics, length of hospitalization, mortality, bleeding, and deep vein thrombosis (DVT) were retrospectively collected and analyzed through bivariate statistical methods. Regression analyses were conducted, with statistically significant patient characteristics as confounding variables, to evaluate the correlation between mortality, bleeding, DVT, length of hospitalization, and prophylactic anticoagulant dose. Results : Of 93 critically-ill COVID-19 patients, 80 (86.0%) received prophylactic AC. Of those, 60 (75.0%) were administered standard AC and 20 (25.0%), higher than standard AC. Length of hospitalization (36.5 days[n=40] vs. 53.9 days[n=18], p=.012), and mortality (33.3% vs. 10.0%, p=.043) showed statistically significant differences between the two groups. Bleeding also occurred in 16 (26.7%) and 8 (40.0%) patients, respectively, but were not significant (p=.260). Mortality, bleeding, DVT, length of hospitalization and prophylactic anticoagulant dose showed no correlation when analyzed through multivariate logistic and multiple regression. Conclusion : No significant association was found between the prophylactic anticoagulant dose and the patients’ clinical outcomes or bleeding occurrence. Further research is needed to evaluate prescription patterns of prophylactic anticoagulants for critically-ill COVID-19 patients including other hospitals and the clinical outcomes with thorough monitoring upon use.
참고문헌 (22)
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