What is it about?
We here compared the survival in two consecutive series of patients, among them overlapping for clinical conditions and hospital path, which have undergone two different perioperative dosages of low-molecular-weight heparin for proximal femoral neck fracture in March-April 2020.
Featured Image
Photo by Graham Ruttan on Unsplash
Why is it important?
Current guidelines from the National Institutes of Health state that there is still insufficient data to recommend either for or against using escalated or therapeutic doses of antithrombotic agents in infected patients, and still the evidences are based on expert opinions. The clinical efficacy of heparin in decreasing mortality rates in COVID-19 has been suggested by colleagues from China and United States of America, but they did not discuss the dose per patient though. It should be considered that most of the evidences on the use of anticoagulants has not been based on trauma older adults. Notably, these patients normally face an already very high risk of basal thromboembolic complications and we therefore believe that surgery with a double dose of anti-thromboembolic prophylaxis represents the most appropriate treatment for these patients with femoral fractures.
Perspectives
Although our results should not be used to support changes in clinical practice because of the observational nature of the study and the lack of statistical significance, older adults receiving a standard dose of anticoagulant were more at risk of death than those receiving a double dose (relative risk 5.14, CI 95% 0.73:36.37). In the near future, we are looking forward to seeing results from large prospective randomized trials that investigate whether higher doses of low-molecular-weight heparin would protect against thrombotic events in COVID-19 patients undergoing surgery. Monitoring of coagulation parameters and bleeding events should be included. In addition, it would be interesting to focus research on the potential antiviral role of heparin.
Dr. M. Briguglio
IRCCS Ospedale Galeazzi - Sant'Ambrogio
Read the Original
This page is a summary of: From Standard to Escalated Anticoagulant Prophylaxis in Fractured Older Adults With SARS-CoV-2 Undergoing Accelerated Orthopedic Surgery, Frontiers in Medicine, October 2020, Frontiers,
DOI: 10.3389/fmed.2020.566770.
You can read the full text:
Resources
Prognosis of severe COVID-19 Italian patients admitted to the ICU
In critically ill COVID-19 patients, it is a fact that respiration support saves lives, but reports from the United States, Canada, United Kingdom, and China have observed survival rates ranging from 15 to 97%, with the dissimilar signs and biochemical fluctuations possibly depending upon the variety of environmental factors and ethnicity.
Original study article
This is the paper that reported the original published article.
Contributors
The following have contributed to this page
