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Predictors of bleeding and thrombotic events among patients admitted to the hospital with COVID-19 and elevated D-dimer: insights from the ACTION randomized clinical trial

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Názov: Predictors of bleeding and thrombotic events among patients admitted to the hospital with COVID-19 and elevated D-dimer: insights from the ACTION randomized clinical trial
Autori: Pedro Gabriel Melo, de Barros E Silva, Remo H M, Furtado, Mariana Silveira, de Alcântara Chaud, Ariane Vieira Scarlatelli, Macedo, Bruna, Bronhara, Lucas Petri, Damiani, Lilian Mazza, Barbosa, Mayra Akimi, Suiama, Eduardo, Ramacciotti, Priscilla, de Aquino Martins, Aryadne Lyrio, de Oliveira, Vinicius Santana, Nunes, Luiz Eduardo Fonteles, Ritt, Ana Thereza, Rocha, Lucas, Tramujas, Sueli V, Santos, Dario Rafael Abregu, Diaz, Lorena Souza, Viana, Lívia Maria Garcia, Melro, Estêvão Lanna, Figueiredo, Fernando Carvalho, Neuenschwander, Marianna Deway Andrade, Dracoulakis, Rodolfo Godinho Souza Dourado, Lima, Vicente Cés, de Souza Dantas, Anne Cristine Silva, Fernandes, Otávio Celso Eluf, Gebara, Mauro Esteves, Hernandes, Diego Aparecido Rios, Queiroz, Viviane C, Veiga, Manoel Fernandes, Canesin, Leonardo Meira, de Faria, Gilson Soares, Feitosa-Filho, Marcelo Basso, Gazzana, Idelzuíta Leandro, Liporace, Aline, de Oliveira Twardowsky, Lilia Nigro, Maia, Flávia Ribeiro, Machado, Alexandre, de Matos Soeiro, Germano Emílio, Conceição-Souza, Luciana, Armaganijan, Patrícia O, Guimarães, Regis G, Rosa, Luciano C P, Azevedo, John H, Alexander, Alvaro, Avezum, Otávio, Berwanger, Alexandre B, Cavalcanti, Renato D, Lopes
Zdroj: Journal of Thrombosis and Thrombolysis. 57:1031-1039
Informácie o vydavateľovi: Springer Science and Business Media LLC, 2024.
Rok vydania: 2024
Predmety: Fibrin Fibrinogen Degradation Products, Male, Hospitalization, Risk Factors, SARS-CoV-2, Humans, COVID-19, Anticoagulants, Hemorrhage, Female, Thrombosis, Middle Aged, Aged
Popis: Therapeutic anticoagulation showed inconsistent results in hospitalized patients with COVID-19 and selection of the best patients to use this strategy still a challenge balancing the risk of thrombotic and hemorrhagic outcomes. The present post-hoc analysis of the ACTION trial evaluated the variables independently associated with both bleeding events (major bleeding or clinically relevant non-major bleeding) and the composite outcomes thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, or major adverse limb events). Variables were assessed one by one with independent logistic regressions and final models were chosen based on Akaike information criteria. The model for bleeding events showed an area under the curve of 0.63 (95% confidence interval [CI] 0.53 to 0.73), while the model for thrombotic events had an area under the curve of 0.72 (95% CI 0.65 to 0.79). Non-invasive respiratory support was associated with thrombotic but not bleeding events, while invasive ventilation was associated with both outcomes (Odds Ratio of 7.03 [95 CI% 1.95 to 25.18] for thrombotic and 3.14 [95% CI 1.11 to 8.84] for bleeding events). Beyond respiratory support, creatinine level (Odds Ratio [OR] 1.01 95% CI 1.00 to 1.02 for every 1.0 mg/dL) and history of coronary disease (OR 3.67; 95% CI 1.32 to 10.29) were also independently associated to the risk of thrombotic events. Non-invasive respiratory support, history of coronary disease, and creatinine level may help to identify hospitalized COVID-19 patients at higher risk of thrombotic complications.ClinicalTrials.gov: NCT04394377.
Druh dokumentu: Article
Jazyk: English
ISSN: 1573-742X
DOI: 10.1007/s11239-024-02995-y
Prístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/38762708
Rights: Springer Nature TDM
Prístupové číslo: edsair.doi.dedup.....d4f1469ede249a098c1bb1817724b907
Databáza: OpenAIRE
Popis
Abstrakt:Therapeutic anticoagulation showed inconsistent results in hospitalized patients with COVID-19 and selection of the best patients to use this strategy still a challenge balancing the risk of thrombotic and hemorrhagic outcomes. The present post-hoc analysis of the ACTION trial evaluated the variables independently associated with both bleeding events (major bleeding or clinically relevant non-major bleeding) and the composite outcomes thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, or major adverse limb events). Variables were assessed one by one with independent logistic regressions and final models were chosen based on Akaike information criteria. The model for bleeding events showed an area under the curve of 0.63 (95% confidence interval [CI] 0.53 to 0.73), while the model for thrombotic events had an area under the curve of 0.72 (95% CI 0.65 to 0.79). Non-invasive respiratory support was associated with thrombotic but not bleeding events, while invasive ventilation was associated with both outcomes (Odds Ratio of 7.03 [95 CI% 1.95 to 25.18] for thrombotic and 3.14 [95% CI 1.11 to 8.84] for bleeding events). Beyond respiratory support, creatinine level (Odds Ratio [OR] 1.01 95% CI 1.00 to 1.02 for every 1.0 mg/dL) and history of coronary disease (OR 3.67; 95% CI 1.32 to 10.29) were also independently associated to the risk of thrombotic events. Non-invasive respiratory support, history of coronary disease, and creatinine level may help to identify hospitalized COVID-19 patients at higher risk of thrombotic complications.ClinicalTrials.gov: NCT04394377.
ISSN:1573742X
DOI:10.1007/s11239-024-02995-y