Page 16 - Highlights of Napcon 2021

Glucocorticoids and Antithrombotic Agents in
COVID-19: Which One, How Long?

Dr. Alok Nath

Additional Professor & Head
Department of Pulmonary Medicine, SGPGIMS
Lucknow

In this outstanding talk, Dr. Alok Nath examined the controversies in the care of critically ill COVID-19 patients.
In particular, he reviewed the clinical-trial evidence about the use of corticosteroids and antithrombotic agents in
critically ill patients with severe COVID-19.

In a WHO meta-analysis, Dr. Nath highlighted that the 28-day mortality was lower in patients randomized to
corticosteroids in a WHO meta-analysis (Figure 1). The benefit was not specific to any particular corticosteroid and
was similar for lower- vs, higher-dose corticosteroids. Moreover, the benefit extends among critically ill patients with
COVID-19 both on and off mechanical ventilation or oxygen, independent of age, gender, duration of the disease
before initiating treatment, the dose, and type of corticosteroids. Therefore, he suggested that corticosteroids can be
used at a dose not exceeding 0.1–0.2 mg/kg of dexamethasone (or equivalent) for up to 10 days in COVID pneumonia
with respiratory failure. The decision to use higher doses of glucocorticoids should be individualized weighing the
risk and benefits. Yet, in the milder form of the disease, the elderly population and individuals with diabetes, the
routine use of corticosteroids remains questionable.

Regarding antithrombotic agents in critically ill patients, Dr. Nath stated that prophylactic doses of anticoagulants are
recommended. Whereas among non-critically ill (moderate) patients with elevated D-dimer levels, therapeutic doses of
anticoagulants are recommended. In addition, routine anticoagulation for post-discharge patients is not recommended.

Figure 1: 28-day mortality in WHO-REACT working group meta-analysis

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Figure 2: Anticoagulation in critically ill COVID-19 patients

14 Highlights of NAPCON 2021