Characterization of the Benefits and Risks of Therapeutic Anticoagulation in Patients Admitted with Severe COVID-19 (CRITAC)
Bibliographic record
Abstract
Background: Severe COVID-19 is associated with increased rates of thrombotic complications. Recent provincial recommendations in British Columbia have suggested providing thromboprophylaxis with therapeutic anticoagulation for hospital inpatients with severe COVID-19 who do not have a high risk of bleeding. Objectives: To characterize the rates of major bleeding, thrombotic events, complications from COVID-19, and adverse effects among patients with severe COVID-19 treated with therapeutic anticoagulation. Methods: This retrospective chart review involved patients with laboratory-confirmed COVID-19 who were admitted to 3 sites within a local health authority between April 1 and December 31, 2021, and received therapeutic anticoagulation for thromboprophylaxis. Results: After screening of 1036 patients, 72 patients were included in the study. The mean age of participants was 54 years, 63% (n = 45) were male, and 92% (n = 66) were receiving supplemental oxygen by nasal prongs on admission. The primary outcome, major bleeding, was experienced by 1 patient (1%). Increasing oxygen requirements resulting in progression to high-flow nasal cannula occurred in 11 patients (15%), and 5 patients (7%) required admission to the intensive care unit. One patient (1%) experienced a thrombotic event, and 1 patient (1%) had a minor bleed. The mean duration of hospitalization was 10 (standard deviation 10.8) days. One death occurred during the study period, and no cases of heparin-induced thrombocytopenia were observed. Conclusions: In this study of hospital inpatients with severe COVID-19 who were deemed to be at low risk of bleeding and who received therapeutic anticoagulation, there were low rates of both major bleeding and thrombotic events. Keywords: COVID-19, therapeutic anticoagulation, thromboprophylaxis, low-molecular-weight heparin RÉSUMÉ Contexte : Les cas graves de COVID-19 sont associés à des taux accrus de complications thrombotiques. De récentes recommandations provinciales en Colombie-Britannique proposent de fournir une thromboprophylaxie avec anticoagulation thérapeutique aux patients hospitalisés atteints d’une forme grave de COVID-19 qui ne présentent pas un risque élevé de saignement. Objectifs : Caractériser les taux d’hémorragies majeures, d’événements thrombotiques, de complications découlant de la COVID-19 et d’effets indésirables chez les patients atteints de COVID-19 sévère traités par anticoagulation thérapeutique. Méthodes : Cette revue rétrospective des dossiers portait sur des patients atteints de COVID-19 confirmée en laboratoire qui ont été admis dans 3 sites au sein d’une autorité sanitaire locale entre le 1er avril et le 31 décembre 2021 et qui ont reçu une anticoagulation thérapeutique pour la thromboprophylaxie. Résultats : Après la présélection de 1036 patients, 72 ont été inclus dans l’étude. L’âge moyen des participants était de 54 ans, 63 % (n = 45) étaient des hommes et 92 % (n = 66) recevaient un supplément d’oxygène par sonde nasale à l’admission. Le critère de jugement principal, une hémorragie majeure, a été observé chez 1 patient (1 %). Une augmentation des besoins en oxygène entraînant une progression vers une canule nasale à haut débit s’est produite chez 11 patients (15 %) et 5 patients (7 %) ont dû être admis à l’unité de soins intensifs. Un patient (1 %) a présenté un événement thrombotique et 1 patient (1 %) a eu un saignement mineur. La durée moyenne d’hospitalisation était de 10 jours (écart type 10,8). Un décès est survenu au cours de la période d’étude et aucun cas de thrombocytopénie induite par l’héparine n’a été observé. Conclusions : Dans cette étude portant sur des patients hospitalisés atteints d’une forme grave de COVID-19, considérés comme présentant un faible risque de saignement et ayant reçu une anticoagulation thérapeutique, les taux d’hémorragies majeures et d’événements thrombotiques étaient faibles. Mots-clés : COVID-19, anticoagulation thérapeutique, thromboprophylaxie, héparine de bas poids moléculair
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".