TOPIC 3: Is there a chance of false negatives in our current practice in terms of infra estimating the true added value of using D-Dimer in when to decide anticoagulation?
* The decision to anticoagulation varies in our program according to where we attend Covid 19 infected patients. In the private practice arena, the decision to when to start anticoagulation is made with more freedom, on the condition of having the patient monitored by a more or less fixed schedule of biomarkers such a D-Dimer (usually every 7 days, or sooner if there is clinical worsening) and to be sensitive to the change of such biomarker. In the public sector arena, we apply a homogenous D-Dimer cut-off for every case (Above 3000 ng/dL), with few exceptions based on a thorough justification sent to the hospital´s administration. Deciding who to give anticoagulation based on an initial D-Dimer level fits the design used in your trial. Nevertheless, D-Dimer is rather used as a temporal biomarker in our private arena. We have found remarkable differences in the overall evolution of the patients attended in the public sector vs the private sector.
TOPIC 4: Which is your estimate that there is more research needed prior to claiming that therapeutic anticoagulation is entirely safe in terms of bleeding risk patients with moderate Covid 19
• Most of the population we attended during the 1st and 2nd waves at Northeast Mexico were largely multimorbid, over a third had CKD, thereof enoxaparin, as the most commonly used agent in your trial seems appealing to apply in our context, yet there were too few patients with CKD included here. Moreover, adherence was a topic addressed in your trial, which was reported to be less than 80% in those therapeutically anticoagulated, would that influence further the precision in claiming safety?
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