It is a great pleasure to have the opportunity to reply to the letter by Nishioka and Imamura (1).Anticoagulation therapy in coronavirus disease 2019 (COVID-19) patients still represents matter of debate, and no adequate randomized trials have been published so far fully addressing the topic. Ideally, anticoagulation therapy could and should prevent thromboembolic events, which have a prevalence of 21–31% in COVID-19 patients requiring ICU hospitalization (2). Unfortunately, recent data showed that previous treatment with oral anticoagulation therapy in COVID-19 patients was associated with higher mortality risk mainly due to coexistent comorbidities (3). Data from a randomized study showed that, among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days (4).Therefore, pathophysiological mechanisms of thrombus formation require additional investigation in COVID-19.Our study focused on anticoagulation in COVID-19 patients with respiratory failure who were treated mainly with low-molecular-weight heparin (LMWH) (therapeutic or prophylactic) (5). Although it is not clear whether therapeutic or prophylactic doses of anticoagulant have different benefits, preliminary nonrandomized data seem to support the hypothesis that patients requiring invasive ventilation could have some benefit in terms of survival. Additionally, it is unclear whether the benefit is driven by those patients where respiratory failure is mainly related to pulmonary embolism or other thromboembolic complications. Additional research is warranted, even for those without respiratory failure that could develop thromboembolic events.In a registry of 420 patients, antiplatelet therapy was associated with lower mortality and ICU admission (6). Therefore, the role of antiplatelets therapy and potential association with prophylactic LMWH certainly deserves additional study, and several randomized trials are focusing on this topic.Currently, therefore, more unanswered questions than sound answer on the topic: next research hopefully would fill this gap in evidence.
Authors: Francesco Santoro; Ivan J Núñez-Gil; María C Viana-Llamas; Charbel Maroun Eid; Rodolfo Romero; Inmaculada Fernández Rozas; Alvaro Aparisi; Victor Manuel Becerra-Muñoz; Marcos García Aguado; Jia Huang; Ludovica Maltese; Enrico Cerrato; Emilio Alfonso-Rodriguez; Alex Fernando Castro Mejía; Francisco Marin; Sergio Raposeiras Roubin; Martino Pepe; Victor H Moreno Munguia; Gisela Feltes; Jesus Varas Navas; Bernardo Cortese; Luis Buzón; Cristoph Liebetrau; Raquel Ramos-Martinez; Antonio Fernandez-Ortiz; Vicente Estrada; Natale Daniele Brunetti Journal: Crit Care Med Date: 2021-06-01 Impact factor: 7.598
Authors: Jonathan H Chow; Ashish K Khanna; Shravan Kethireddy; David Yamane; Andrea Levine; Amanda M Jackson; Michael T McCurdy; Ali Tabatabai; Gagan Kumar; Paul Park; Ivy Benjenk; Jay Menaker; Nayab Ahmed; Evan Glidewell; Elizabeth Presutto; Shannon Cain; Naeha Haridasa; Wesley Field; Jacob G Fowler; Duy Trinh; Kathleen N Johnson; Aman Kaur; Amanda Lee; Kyle Sebastian; Allison Ulrich; Salvador Peña; Ross Carpenter; Shruti Sudhakar; Pushpinder Uppal; Benjamin T Fedeles; Aaron Sachs; Layth Dahbour; William Teeter; Kenichi Tanaka; Samuel M Galvagno; Daniel L Herr; Thomas M Scalea; Michael A Mazzeffi Journal: Anesth Analg Date: 2021-04-01 Impact factor: 5.108
Authors: José Miguel Rivera-Caravaca; Iván J Núñez-Gil; David Vivas; María C Viana-Llamas; Aitor Uribarri; Víctor Manuel Becerra-Muñoz; Daniela Trabattoni; Inmaculada Fernández Rozas; Gisela Feltes; Javier López-Pais; Ibrahim El-Battrawy; Carlos Macaya; Antonio Fernandez-Ortiz; Vicente Estrada; Francisco Marín Journal: Eur J Clin Invest Date: 2020-11-07 Impact factor: 5.722