Anticoagulation Associated With Improved Outcomes in Hospitalized COVID-19 Patients

Systemic anticoagulation may be associated with improved outcomes among patients hospitalized with COVID-19, according to a research letter published May 6 in the Journal of the American College of Cardiology.

Ishan Paranjpe, BS, and Valentin Fuster, MD, PhD, MACC, et al., analyzed the association between in-hospital anticoagulation administration and mortality among patients hospitalized with COVID-19. The researchers adjusted for age; sex; ethnicity; history of hypertension, heart failure, atrial fibrillation and type 2 diabetes; anticoagulation use prior to hospitalization; and admission date. In addition, duration of anticoagulation treatment was used as a covariate and intubation was treated as a time-dependent variable.

Of 2,773 hospitalized COVID-19 patients, 786 (28%) received systemic anticoagulation during their hospital stay. The median length of stay was five days, while the median time from admission to anticoagulation initiation was two days and the median anticoagulation treatment was three days. Among patients who received anticoagulation, in-hospital mortality was 22.5% with a median survival of 21 days, compared with 22.8% and a median survival of 14 days among patients who did not receive anticoagulation.

Patients who received anticoagulation were more likely to require mechanical ventilation (29.8% vs. 8.1%). In-hospital mortality among patients requiring mechanical ventilation was 29.1% with a median survival of 21 days for those receiving anticoagulation vs. 62.7% with a median survival of nine days for patients not receiving anticoagulation. Longer duration of anticoagulation treatment was associated with a reduced mortality risk (adjusted hazard ratio, 0.86 per day; 95% confidence interval 0.82 to 0.89; p<0.001). In addition, 24 patients (3%) who received anticoagulation had bleeding events, compared with 38 patients (1.9%) among those who did not receive anticoagulation. Bleeding events were more common among patients who were intubated (7.5%) vs. nonintubated patients (1.35%).

According to the researchers, anticoagulation may be associated with improved outcomes in COVID-19 patients, but the benefits should be weighed against the risk of bleeding. The findings provide clinical insights for hospitalized COVID-19 patients, but additional research is needed to determine whether systemic anticoagulation is associated with increased survival, the researchers conclude.

It must be noted that in an observational study like this it is very difficult to gauge treatment effects in the presence of unmeasured confounders and inherent treatment biases that may exist, commented Kim A. Eagle, MD, MACC, ACC.org Editor-in-Chief. "Nevertheless, studies to date suggest that COVID-19 is often associated with heightened coagulation and it stands to reason that anticoagulants have an important role to reduce clinically important procoagulant clinical events including deep vein thrombosis, pulmonary embolism and stroke."

Clinical Topics: Anticoagulation Management

Keywords: Coronavirus, Anticoagulants, Hospital Mortality, Diabetes Mellitus, Type 2, Respiration, Artificial, COVID-19, severe acute respiratory syndrome coronavirus 2


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