Assessing differential application of thromboprophylaxis regimes related to risk of pulmonary embolism and mortality in COVID-19 patients through instrumental variable analysis.

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Tác giả: Folkert W Asselbergs, Albertus Beishuizen, Remy H H Bemelmans, Suzanne C Cannegieter, F Nanne Croles, C Peter C de Jager, Corstiaan A den Uil, Menno V Huisman, Pieter W Kamphuisen, Frederikus A Klok, Stephanie C E Koster, Marieke J H A Kruip, Nuray Kuşadasi, Saskia le Cessie, Marijke P M Linschoten, Karina Meijer, Linda Nab, Marten R Nijziel, Roger E G Schutgens, Frank Stam, Hugo Ten Cate, Bas C T van Bussel, Coen van Guldener, Chantal Visser, Alexander P J Vlaar, Eline A Vlot

Ngôn ngữ: eng

Ký hiệu phân loại: 658.32259 Personnel management (Human resource management)

Thông tin xuất bản: England : Scientific reports , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 742651

Thrombotic complications are common in Coronavirus disease 2019 (COVID-19) patients, with pulmonary embolism (PE) being the most frequent. Randomised trials have provided inconclusive results on the optimal dosage of thromboprophylaxis in critically ill COVID-19 patients. We utilized data from the multicentre CAPACITY-COVID patient registry to assess the effect of differential application of Low Molecular Weight Heparin (LMWH) dose protocols on PE and in-hospital mortality risk in critically ill COVID-19 patients. An instrumental variable analysis was performed to estimate the intention-to-treat effect, utilizing differences in thromboprophylaxis prescribing behaviour between hospitals. We included 939 patients with PCR confirmed SARS-CoV-2 infection from 34 hospitals. Two-hundred-and-one patients (21%) developed a PE. The adjusted cause-specific HR of PE was 0.92 (95% CI: 0.73-1.16) per doubling of LMWH dose. The adjusted cause-specific HR for in-hospital mortality was 0.82 (95% CI: 0.65-1.02) per doubling of LMWH dose. This dose-response relationship was shown to be non-linear. To conclude, this study did not find evidence for an effect of LMWH dose on the risk of PE, but suggested a non-linear decreased risk of in-hospital mortality for higher doses of LMWH. However, uncertainty remains, and the dose-response relationship between LMWH dose and in-hospital mortality needs further investigation in well-designed studies.
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