Key result
Treatment doses of anticoagulation in critically ill COVID-19 patients with new-onset atrial fibrillation did not significantly increase major bleeding compared to prophylactic doses (OR 1.46).
Why the study?
To evaluate the effectiveness and safety of anticoagulation regimens in COVID-19 critically ill patients with new-onset atrial fibrillation during their ICU stays.
Does treatment dose anticoagulation compared to prophylaxis dose anticoagulation improve outcomes or increase bleeding in critically ill COVID-19 patients with new-onset atrial fibrillation?
Cohort (n=56)
Yes
Does treatment dose anticoagulation compared to prophylaxis dose anticoagulation improve outcomes or increase bleeding in critically ill COVID-19 patients with new-onset atrial fibrillation?
Odds Ratio: 1.46 (95% CI 0.29–7.42)
Absolute Event Rate: 14.3% vs 10.7%
p-value: p=0.65
In critically ill COVID-19 patients with new-onset atrial fibrillation, therapeutic anticoagulation did not improve clinical outcomes compared to prophylactic dosing but significantly increased the need for red blood cell transfusions.
Treatment anticoagulation showed no efficacy advantage over prophylaxis in this cohort; leaves open optimal dosing pending RCTs.
Purpose: To evaluate the effectiveness and safety of anticoagulation regimens in COVID-19 critically ill patients with new-onset Atrial fibrillation (Afib) during their intensive care unit (ICU) stays. Methods: A multicenter, retrospective cohort study included critically ill patients with COVID-19 admitted to the ICUs. Patients with new-onset Afib were categorized into two groups based on anticoagulation doses (Prophylaxis vs Treatment). The primary outcome was the bleeding rate; other outcomes were considered secondary. Logistic, negative binomial regression, and Cox proportional hazards regression analyses were applied as appropriate after PS matching. Results: A total of 107 patients were eligible. After PS matching (1:1 ratio), 56 patients were included in the final analysis. A higher odd for major and minor bleeding were observed in the patients who received treatment doses of anticoagulation; however, it did not reach the statistically significant (OR 1.46; 95% CI 0.29, 7.42; P =0.65 and OR 2.04; 95% CI 0.17, 24.3; P =0.57, respectively). The hospital length of stay and in-hospital mortality showed no differences between the two groups (beta coefficient − 0.00; CI − 0.38, 0.37; P =0.99 and HR 1.12, 95% CI 0.58– 2.14; p = 0.74, respectively). On the other hand, patients in the treatment group had a statistically significant higher requirement of RBCs transfusion than patients who received a prophylaxis dose (beta coefficient 1.17; 95% CI 0.11, 2.22, P= 0.03). Conclusion: The use of treatment anticoagulation doses in COVID-19 critically ill patients with new-onset Afib did not show better effectiveness over prophylactic anticoagulation doses; however, patients who received treatment anticoagulation doses had higher RBCs transfusion requirements. Our results must be cautious; thus, larger randomized interventional studies with a larger sample size are required to confirm our findings.
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Sulaiman et al. (2024) conducted a cohort in COVID-19 with new-onset atrial fibrillation (n=56). Treatment dose anticoagulation vs. Prophylactic dose anticoagulation was evaluated on Major bleeding rate (OR 1.46, 95% CI 0.29-7.42, p=0.65). Treatment doses of anticoagulation in critically ill COVID-19 patients with new-onset atrial fibrillation did not significantly increase major bleeding compared to prophylactic doses (OR 1.46).
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