Association of anticoagulation dose and survival in hospitalized COVID-19 patients: A retrospective propensity score-weighted analysis.
COVID-19
anticoagulation
heparin
novel coronavirus
Journal
European journal of haematology
ISSN: 1600-0609
Titre abrégé: Eur J Haematol
Pays: England
ID NLM: 8703985
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
16
09
2020
revised:
06
10
2020
accepted:
07
10
2020
pubmed:
13
10
2020
medline:
2
2
2021
entrez:
12
10
2020
Statut:
ppublish
Résumé
Hypercoagulability may contribute to COVID-19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear. We evaluated the impact on survival of different AC doses in COVID-19 patients. Retrospective, multi-center cohort study of consecutive COVID-19 patients hospitalized between March 13 and May 5, 2020. A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n = 642) required intensive care unit (ICU) stay. 60.9% received pAC (n = 2121), 28.7% received ≥3 days of tAC (n = 998), and 10.4% (n = 361) received no AC. Propensity score (PS) weighted Kaplan-Meier plot demonstrated different 25-day survival probability in the tAC and pAC groups (57.5% vs 50.7%). In a PS-weighted multivariate proportional hazards model, AC was associated with reduced risk of death at prophylactic (hazard ratio [HR] 0.35 [95% confidence interval {CI} 0.22-0.54]) and therapeutic doses (HR 0.14 [95% CI 0.05-0.23]) compared to no AC. Major bleeding occurred more frequently in tAC patients (81 [8.1%]) compared to no AC (20 [5.5%]) or pAC (46 [2.2%]) subjects. Higher doses of AC were associated with lower mortality in hospitalized COVID-19 patients. Prospective evaluation of efficacy and risk of AC in COVID-19 is warranted.
Sections du résumé
BACKGROUND
BACKGROUND
Hypercoagulability may contribute to COVID-19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear.
OBJECTIVES
OBJECTIVE
We evaluated the impact on survival of different AC doses in COVID-19 patients.
METHODS
METHODS
Retrospective, multi-center cohort study of consecutive COVID-19 patients hospitalized between March 13 and May 5, 2020.
RESULTS
RESULTS
A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n = 642) required intensive care unit (ICU) stay. 60.9% received pAC (n = 2121), 28.7% received ≥3 days of tAC (n = 998), and 10.4% (n = 361) received no AC. Propensity score (PS) weighted Kaplan-Meier plot demonstrated different 25-day survival probability in the tAC and pAC groups (57.5% vs 50.7%). In a PS-weighted multivariate proportional hazards model, AC was associated with reduced risk of death at prophylactic (hazard ratio [HR] 0.35 [95% confidence interval {CI} 0.22-0.54]) and therapeutic doses (HR 0.14 [95% CI 0.05-0.23]) compared to no AC. Major bleeding occurred more frequently in tAC patients (81 [8.1%]) compared to no AC (20 [5.5%]) or pAC (46 [2.2%]) subjects.
CONCLUSIONS
CONCLUSIONS
Higher doses of AC were associated with lower mortality in hospitalized COVID-19 patients. Prospective evaluation of efficacy and risk of AC in COVID-19 is warranted.
Identifiants
pubmed: 33043484
doi: 10.1111/ejh.13533
pmc: PMC7675265
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
165-174Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
J Thromb Haemost. 2020 Jun;18(6):1517-1519
pubmed: 32294295
J Am Coll Cardiol. 2020 Jul 7;76(1):122-124
pubmed: 32387623
Lancet Haematol. 2020 Aug;7(8):e575-e582
pubmed: 32619411
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
J Thromb Haemost. 2020 Jun;18(6):1324-1329
pubmed: 32306492
Am J Hematol. 2020 Jul;95(7):834-847
pubmed: 32282949
Blood. 2020 Jun 4;135(23):2033-2040
pubmed: 32339221
Lancet Respir Med. 2020 Jul;8(7):681-686
pubmed: 32473124
Eur J Haematol. 2021 Feb;106(2):165-174
pubmed: 33043484
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094
J Thromb Haemost. 2020 May;18(5):1233-1234
pubmed: 32291954
J Am Coll Cardiol. 2020 Oct 20;76(16):1815-1826
pubmed: 32860872
Ann Intern Med. 2011 Nov 1;155(9):602-15
pubmed: 22041949
J Thromb Haemost. 2020 Jul;18(7):1747-1751
pubmed: 32302448
TH Open. 2020 Sep 26;4(3):e263-e270
pubmed: 32995704
Transl Res. 2020 Jun;220:1-13
pubmed: 32299776
J Thromb Haemost. 2020 Jul;18(7):1738-1742
pubmed: 32302438
N Engl J Med. 2020 Apr 23;382(17):e38
pubmed: 32268022