Use of in-hospital anticoagulation and mortality in hospitalized COVID-19 patients
Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19
Literature - Paranjpe I, Fuster V, Lala A, et al. - J Am Coll Cardiol 2020, doi: https://doi.org/10.1016/j.jacc.2020.05.001Introduction and methods
High incidence of thrombotic complications have been observed in hospitalized COVID-19 patients [1,2]. There are anecdotal observations of improved outcomes with systemic anticoagulation, but the role of anticoagulation in management of COVID-19 patients is not known [3,4]. Therefore, this study examined the association between use of in-hospital anticoagulation and survival in a large cohort of COVID-19 patients.
Of 2773 hospitalized COVID-19 patients within the Mount Sinai Health System in New York City between March 14 and April 11, 2020, 786 (28%) patients received anticoagulation during hospital stay.
Main results
- Patients treated with anticoagulation had a in-hospital mortality rate of 22.5% with a median survival of 21 days, compared to 22.8% and median survival of 14 days in patients who did not receive anticoagulation.
- Patients who received anticoagulation more often required invasive mechanical ventilation than those without anticoagulation (29.8% vs. 8.1, P<0.001).
- Those who received anticoagulation had significantly increased baseline prothrombin time, activated partial thromboplastin time, lactate dehydrogenase, ferritin, C reactive protein, and D-dimer levels compared to patients who did not receive anticoagulation.
- Among those who required mechanical ventilation (n=395), patients who received anticoagulation had an in-hospital mortality rate of 29.1% with a median survival of 21 days and those who did not receive anticoagulation mortality rate was 62.7% with a median survival of 9 days.
- Longer duration of anticoagulation treatment was associated with reduced risk of mortality (adjusted HR 0.86, 95%CI: 0.82-0.89, P<0.001).
- 24 Patients (3%) who received anticoagulation had (major) bleeding events compared to 38 (1.9%) patients who did not receive anticoagulation (P=0.02).
Conclusion
The authors conclude that these findings suggest that systemic anticoagulation may be associated with improved outcomes in patients hospitalized with COVID-19. They note, however, that benefit of systemic anticoagulation needs to weighted against risk of bleeding. The association between administration of anticoagulation and mechanical ventilation likely reflects more severe clinical presentation of patients who require anticoagulation.
References
1. Lillicrap D. Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia. J. Thromb. Haemost. 2020;
2. Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med 2020;
3. Yin S, Huang M, Li D, Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. J Thromb Thrombolysis 2020;
4. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020;
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