Impact of implementation of an individualised thromboprophylaxis protocol in critically ill ICU patients with COVID-19: A longitudinal controlled before-after study

Björn Stessel, Charlotte Vanvuchelen, Liesbeth Bruckers, Laurien Geebelen, Ina Callebaut, Jeroen Vandenbrande, Ben Pellens, Michiel Van Tornout, Jean-Paul Ory, Karlijn van Halem, Peter Messiaen, Lieven Herbots, Dirk Ramaekers, Jasperina Dubois, Björn Stessel, Charlotte Vanvuchelen, Liesbeth Bruckers, Laurien Geebelen, Ina Callebaut, Jeroen Vandenbrande, Ben Pellens, Michiel Van Tornout, Jean-Paul Ory, Karlijn van Halem, Peter Messiaen, Lieven Herbots, Dirk Ramaekers, Jasperina Dubois

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.

Registration number: NCT04394000.

Keywords: COVID-19; Continuous renal replacement therapy; Mortality; Thromboprophylaxis; Venous thromboembolism.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no conflicting interests. The authors affirm that this study has not received any funding/assistance from a commercial organization, and we do not keep any commercial relationships that may lead to a conflict of interests.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Overview of the individualised and intensified thromboprophylaxis protocol implemented on March 30th 2020. DVT: deep venous thrombosis, LMWH: low molecular weight heparin.
Fig. 2
Fig. 2
Mortality at 1 week, 2 weeks, 3 weeks and 1 month. All patients in the before group and after group had one month follow-up.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/7375318/bin/fx1_lrg.jpg

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Source: PubMed

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