PB0073 - A Retrospective Study of Two Anticoagulation Therapies In Critically Ill Covid-19 Patients Prior To Vaccination Era

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Rubens Carmo Costa-Filho, MD, MBA, FCCP (he/him/his)

Doctorate at immunopharmacology lab at FIOCRUZ/IOC - RJ
Fiocruz/ IOC RJ
Rio de Janeiro, Rio de Janeiro, Brazil

Co-Author(s)

AO

Amarino Oliveira, Jr.

Senior radiologist assistant at the Department of Radiology of Hospital Pró-Cardíaco,
Hospital das Américas - UHG
Rio de Janeiro, Rio de Janeiro, Brazil
EF

Eduardo de Moraes Furtado

Staff senior of Canal Analytica, RJ
Empresa Brasileira de Serviços Hospitalares - EBSERH
Rio de janeiro, Rio de Janeiro, Brazil
FS

Felipe Saddy

MD, PhD Professor and Critical Care Coordinator of Hospital Pró Cardíaco - RJ
Hospital das Américas, RJ - UHG
Rio de Janeiro, Rio de Janeiro, Brazil
Rd

Rômulo Cristóvão de Souza

Professor at UERJ and Director at Canal Analytica
Faculdade de Ciências Médicas, universidade do estado do rio de janeiro (UERJ)
Rio de Janeiro, Rio de Janeiro, Brazil
MA

Marcela Santos Azevedo

Academic at Faculdade de Medicina, Campus Vista Carioca, Universidade Estácio de Sá
Immunopharmacoly laboratory at Fiocruz/IOC RJ
Rio de Janeiro, Rio de Janeiro, Brazil
DC

Débora Fragoso Cerqueira

Academic at Faculdade de Medicina, Campus Vista Carioca, Universidade Estácio de Sá
Immunopharmacology Laboratory at FIOCRUZ/IOC - RJ
Rio de Janeiro, Rio de Janeiro, Brazil
VG

Vitor Hugo Amaral Gualberto

Academic at
Faculdade de Medicina, Campus Vista Carioca, Universidade Estácio de Sá
Rio de Janeiro, Rio de Janeiro, Brazil
JC

João Luiz Ferreira Costa

Coordinator of department of Dialysis and nephrology at Hospital Pró Cardíaco
Senior physician of Nefro Clinicas (RJ)
Rio de Janeiro, Rio de Janeiro, Brazil
HC

Hugo Caire Castro-Faria-Neto

MD,PhD full professor, immunopharmacology, Fiocruz/IOC - RJ
Research at immunopharmacology, Fiocruz/IOC - RJ
Rio de Janeiro, Rio de Janeiro, Brazil

Background: A high risk of thrombotic events characterize COVID-19 patients. Anticoagulation/thromboprophylaxis reduces thrombotic complications and improves outcomes. The choice of anticoagulation/thromboprophylaxis is still a topic of debate. We previously showed that Apixaban inhibits Mpro activity and has anti-SARS-CoV-2 activity. This study explores the benefits of Novel Oral Anticoagulants (NOACs) vs Heparin in severe COVID-19 patients.

Aims: This retrospective cohort study weighs the benefits of NOACs vs heparins in critically ill COVID-19 patients before the widespread availability of vaccines.

Methods: This study analyzed 76 consecutively hospitalized patients from March to December 2020 in a single medical center. Data on these patients' medical history, laboratory results and outcomes were collected from Epimed Monitor ICU Database® and included patient demographics, SAPS3 score, D-Dimer levels, Charlson score, modified frailty index (MFI), BMI, computerized tomography scores, IMPROVEDD score, hospital length of stay (LOS). The outcomes, including bleeding/thrombosis and mortality, were analyzed on an intention-to-treat basis.

Results: Patients in the Heparins and NOACs groups were clinically similar, as demonstrated by comparable median values for age (76 vs 74), BMI (26.3 vs 26.9), SAPS3 (56 vs 54), ImproveDD score (5 vs 5), Charlson score (1 vs 1), and Modified Frailty Index (2 vs 2). There were distinct differences in D-dimer levels (2,281 ng/mL vs 4,693 ng/mL), Lung CT score (2= 26-50% vs 3 = 51-75% of the lungs affected), and Hospital LOS (14 vs 18 days). Mortality was lower in the NOACs group (51.2 vs 20%)

Conclusion(s): The mortality rate in the Heparin group was 2.56 times higher, despite better Lung CT score and D-dimer levels than the NOAC group. Both groups had an insignificant bleeding rate with no known major thrombotic events. This study suggests that the administration of NOACs, particularly Apixaban, is safe and has revealed superior outcomes in patients with severe COVID-19.