Systemic anticoagulation may improve outcomes in COVID-19 hospitalizations
Patients hospitalized with COVID-19 who received systemic anticoagulation had improved mortality rates compared with those who did not receive the treatment, according to a research letter published in the Journal of the American College of Cardiology.
“The potential benefits of systemic anticoagulation, however, need to be weighed against the risk of bleeding and therefore should be individualized,” Ishan Paranjpe, researcher at Hasso Plattner Institute for Digital Health at Mount Sinai and a medical student at Icahn School of Medicine at Mount Sinai, and colleagues wrote.
Researchers analyzed data from 2,773 patients hospitalized with COVID-19 in the Mount Sinai Health System in New York City between March 14 and April 11. Anticoagulation assessed in this study included oral, subcutaneous and IV forms. Data were adjusted for sex, age, BMI, ethnicity, anticoagulation use before hospitalization, admission date and a history of HF, hypertension, type 2 diabetes and atrial fibrillation.
Among the cohort, 28% received systemic anticoagulation for a median of 3 days during a median hospitalization of 5 days.
In-hospital mortality occurred in 22.5% of patients treated with anticoagulation vs. 22.8% of those who did not receive the treatment. The median survival was 21 days for patients treated with anticoagulation and 14 days for those who did not receive anticoagulation.
Patients treated with anticoagulation during hospitalization were more likely to need invasive mechanical ventilation vs. those who did not receive the treatment (29.8% vs. 8.1%; P < .001).
Among patients requiring mechanical ventilation (n = 395), in-hospital mortality occurred in 29.1% of those treated with anticoagulation compared with 62.7% of those who did not receive anticoagulation during hospitalization. Median survival was 21 days for the anticoagulation group and 9 days for the non-anticoagulation group.
In a multivariate model, longer duration of anticoagulation treatment was linked to reduced risk for mortality (adjusted HR per day = 0.86; 95% CI, 0.82-0.89).
Bleeding events occurred in 1.9% of patients who did not receive anticoagulation compared with 3% who did receive the treatment (P = .2). More events occurred after anticoagulation initiation compared with before the treatment (63% vs. 37%). Patients who were intubated were more likely to have bleeding events compared with those who were not intubated (7.5% vs. 1.35%).
“These data, derived from a large United States cohort, provide clinical insights for consideration in the management of patients hospitalized with COVID-19,” Paranjpe and colleagues wrote. “Prospective randomized trials are needed to determine whether systemic anticoagulation confers a survival benefit in hospitalized patients with COVID-19.”
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio. – by Darlene Dobkowski
Disclosures: Paranjpe reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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