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Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19

Background: COVID – 19 appears to be associated with a hypercoagulable state manifested by frequent abnormalities of clotting and observed thrombotic clinical events.

Clinical Question: Does the use of systemic anticoagulants (oral, subcutaneous or intravenous) have a positive clinical impact on outcomes for COVID – 19.

Study: Single-center (Mount Sinai Health System in New York City), retrospective analysis of the effect of a therapeutic anticoagulant (AC) treatment dose on the outcome of patients with laboratory diagnosed COVID – 19.

Key Points:

 

  • Of 2773 hospitalized patients with COVID – 19, 786 (28%) were treated with systemic, therapeutic doses of AC at a median time to AC of 2 days.
  • Patients treated with AC had an In-hospital mortality of 22.5% with a median survival of 21 days; patients not receiving AC had a 22.8% mortality with a median survival of 14 days.
  • AC patients more often required mechanical ventilation (29.8 vs. 8.1%, p<0.001).
  • Mechanical ventilation was required in 395 patients with a mortality of 29.1% and a median survival of 21 days for AC patients compared to a mortality of 62.7% and median survival of 9 days for those not receiving AC.
  • Major bleeding was low in both groups with a non-significant increase in bleeding events 3.0% for the AC group compared to 1.9% for the non-anticoagulated patients (p=0.2) including approximately 1/3 of events before the introduction of treatment in the AC group.
  • Bleeding events were more common in intubated patients regardless of whether or not they received AC (7.5 vs. 1.35%).
  • In summary, while this retrospective study has limitations, Given the recognized frequent hypercoagulability of CODID – 19 patients and the associated observed frequent thrombotic events, a prospective analysis of the impact of AC is warranted.