CHEST Guidelines-COVID-19-in-the-Critically-Ill

COVID-19-in-the-Critically-Ill_chest

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The letter to the editor discusses a study by Tacquard et al., published in CHEST, advocating increased anticoagulation dosing in critically ill COVID-19 patients. The study found a reduction in thrombosis rates with higher heparin doses without apparent increases in bleeding complications. However, the authors of the letter express concerns, cautioning against the adoption of such therapeutic strategies due to the potential for significant bleeding risks, especially among critically ill patients. They reference data showing bleeding events in 7.6% of critically ill COVID-19 patients, with major bleeding at 5.6%.<br /><br />Concerns also include methodological critiques such as the need to differentiate between high and intermediate anticoagulation doses for clearer analysis. Furthermore, the authors of the letter suggest that other thrombotic complications and bleeding associated with extracorporeal circuits, which often cause serious events, were not adequately distinguished and categorized by severity in Tacquard et al.’s study.<br /><br />Rates of thrombotic complications like deep venous thrombosis and pulmonary embolism in the study are noted to be comparable to typical ICU scenarios, bringing into question the overall impact of thrombosis in COVID-19 cases. The variability in thrombotic complications, dependent on assessment methods and types of events studied, further underscores this uncertainty. Additionally, the letter highlights the unexamined role of immunothrombosis in Tacquard et al.’s study, which could impact the understanding and management of thrombosis in COVID-19 patients.<br /><br />The letter concludes by stressing the importance of using biomarkers to guide treatment decisions, allowing for tailored therapies that can better stratify thrombotic and hemorrhagic risks, ideally at earlier stages of the disease when less risk is present. The authors call for a more individualized treatment strategy to improve outcomes.

Keywords

anticoagulation

COVID-19

thrombosis

bleeding risks

heparin dosing

critically ill patients

methodological critiques

immunothrombosis

biomarkers

individualized treatment