TABLE 1 : Comparison Between Patients in which Guidelines Were Employed ( Group A ) Versus Those Patients in which Guidelines Were Not Employed ( Group B )
Variable
Age ( Years )
Body Mass Index
molecular weight heparin is preferred because of physicians ' long experience with these agents . There are no studies on the therapeutic intensity of fondaparinux , argatroban , or bivalirudin in this population . 8
There have been several studies that have influenced the development of guidelines . A study by Rentsch et al . evaluated prophylactic doses of anticoagulation within 24 hours of admission compared to no anticoagulation . 9 They found a 14 % mortality for those who received prophylactic anticoagulation versus 19 % mortality for those not on anticoagulation . 9 There were no differences between the groups in risk of bleeding that required transfusion , and they concluded that COVID-19 patients could benefit from prophylactic dosing of anticoagulants . 9
The investigators of three large clinical trials combined concluded that there was
Group A N = 150
Median : 71 ( range : 28-99 )
Mean ± Standard Deviation : 28.2 ± 5.5
a survival benefit to anticoagulation . 10 In a clinical trial in which therapeutic heparin was compared to prophylactic heparin in moderately ill COVID-19 patients , the odds of death at 28 days were decreased . 11 In another clinical trial by Spyropoulos et al ., in patients not receiving intensive care unit ( ICU ) care showed LMWH at a therapeutic dose reduced death and thromboembolism . 12 Our study aimed to examine the treatment patterns of antithrombotic therapies in non-critically ill COVID-19 patients at our institution in relation to the aforementioned published guidelines .
METHODS
Group B N = 105
Median : 71 ( range : 21-99 )
Mean ± Standard Deviation : 27.8 ± 5.8
P Value
Variable Group A % ( n ) Group B % ( n ) P value Sex ( Female ) 49.3 ( 74 ) 52.4 ( 55 ) . 63 Smoking in Last 30 Days 22.7 ( 34 ) 24.8 ( 26 ) . 70 Diabetes 35.3 ( 53 ) 46.7 ( 49 ) . 07 Chronic Obstructive Pulmonary Disease 46.7 ( 70 ) 40 ( 42 ) . 29 Asthma 6.7 ( 10 ) 4.8 ( 5 ) . 52 Hypertension 75.3 ( 113 ) 81.0 ( 85 ) . 30 Active Cancer 10.7 ( 16 ) 11.4 ( 12 ) . 85 Rheumatoid Arthritics 2 ( 3 ) 2.9 ( 3 ) . 66
Immunocompromised Non-Human Immunodeficiency Virus
. 71
. 53
14.7 ( 22 ) 18.1 ( 19 ) . 46
History of Cardiovascular Disease 36 ( 54 ) 39.0 ( 41 ) . 62 Heart Failure 24 ( 36 ) 21.9 ( 23 ) . 70 Chronic Kidney Failure ( Stage 3 ) 15.3 ( 23 ) 39 ( 41 ) < . 001 Liver Disease 3.3 ( 5 ) 4.8 ( 5 ) . 74
Our institution ’ s COVID-19 response team created an inpatient data registry at the onset of the pandemic . Variables were selected and operationally defined . The infection prevention department personnel identified patients with a diagnosis of COVID-19 . All patients had at least one PCR positive test . Patients were screened for registry inclusion by the research coordinator , a trained research nurse who then reviewed the medical record and entered information into the database . Patients were excluded from the registry if they were treated and released from the emergency department or were identified as COVID-19 PCR positive through inpatient surveillance testing but were asymptomatic . In addition , patients less than 18 years old receiving ICU care with body mass index ( BMI ) at 40 or greater and chronic kidney disease with glomerular filtration rate ( GFR ) of less than 30 ml / min were excluded from the study . Two hundred and fifty-five met the inclusion criteria .
Patients were categorized into two groups . Those determined to have antithrombic use consistent with current guidelines were assigned to Group A . Group A patients received LMWH or remained on an oral anticoagulant agent for a known condition , or those placed on intravenous ( IV ) UFH initially for a suspected thrombotic event and subsequently changed to LMWH after the condition was ruled out . Group B patients included those whose treatment was not consistent with guidelines ; specifically , patients initially placed on UFH with no contraindications to LMWH . In addition , those patients who were not treated with any antithrombotic drugs and had no contraindication or those left on IV UFH after a suspected thrombotic event that was subsequently ruled out were also determined to have received treatment not consistent with guidelines .
Statistical comparisons were made between Group A and B using SAS 9.4 for demographics and comorbidities . The data were analyzed in SAS 9.4 . Categorical variables are presented as proportions , and either a Chi-square test or Fisher ’ s Exact test was performed depending on the numbers present for the variable . Continuous variables are reported as means ± standard deviation or medians were appropriate . Student ’ s t-tests were done on normally distributed continuous variables , and nonparametric tests ( Wilcoxon ) were performed on continuous data with non-normal distributions .
West Virginia Medical Journal • March 2024 • 21