J Clin Pharmacol. 2020 Sep 3. doi: 10.1002/jcph.1749. Online ahead of print.
The pathophysiology of respiratory failure associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains under investigation. One hypothesis is that progressive endothelial damage from the virus leads to microvascular thrombosis. It is uncertain if empiric therapeutic anticoagulation provides benefit over standard deep vein thrombosis (DVT) prophylaxis in critically ill patients with SARS-CoV-2. A retrospective cohort study was performed to evaluate adult patients admitted to the intensive care unit at three hospitals with PCR-confirmed SARS-CoV-2 associated respiratory failure requiring invasive mechanical ventilation. A Kaplan-Meier survival analysis was used to compare patients who were initiated on therapeutic anticoagulation prior to the time of intubation, and those receiving standard DVT prophylaxis doses. The primary outcome was the difference in the 28-day mortality of patients between the two groups. 28-day mortality was not different between groups, occurring in 26.1% in patients who received therapeutic anticoagulation and 29.5% in those who received a prophylaxis dose only (hazard ratio 0.52, p = 0.055). There was no difference in 28-day mortality between groups in patients who were admitted with a serum D-dimer greater than or equal to 2 mcg/mL (hazard ratio 0.67, p = 0.41). Empiric therapeutic anticoagulation in patients who require invasive mechanical ventilation for confirmed SARS-CoV-2 infection does not improve 28-day mortality when compared to standard DVT prophylaxis, even among those with elevated D-dimer levels. This article is protected by copyright. All rights reserved.