Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients.
%, percentage
(n), number
ACEi, angiotensin-converting enzyme inhibitors
ARBs, angiotensin receptor blockers
Anticoagulation
CI, confidence intervals
CKD, chronic kidney disease
CO2, carbon dioxide
COPD, chronic obstructive pulmonary disease
COVID-19
COVID-19, coronavirus disease 2019
D-dimer
DIC, disseminated intravascular coagulation
DOAC, direct oral anticoagulant
EHR, electronic health records
EMR, electronic medical records
HCT, hematocrit
HIT, heparin-induced thrombocytopenia
HR, hazard ratio
Hospitalization
IPAC, inpatient anticoagulation therapy
IRB, institutional review board
Inpatient
MI, prior myocardial infarction
Mortality
OPAC, outpatient persistent anticoagulation therapy
Outpatient
RDW, red blood cell distribution width
SARS-CoV-2, severe Acute Respiratory Syndrome Coronavirus-2
SBP, systolic blood pressure
SBP-min, minimum systolic blood pressure
SD, standard deviations
SE, standard errors
SpO2-min, minimum oxygen saturation
T1DM, type 1 diabetes mellitus
T2DM, type 2 diabetes mellitus
VTE, venous thromboembolism
WBC, white blood cell
mg/dl, milligram per deciliter
rt-PCR, reverse transcriptase-polymerase chain reaction
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
31
03
2021
revised:
27
08
2021
accepted:
07
09
2021
entrez:
29
9
2021
pubmed:
30
9
2021
medline:
30
9
2021
Statut:
ppublish
Résumé
Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality. We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk. Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% ( Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk. No funding was obtained for this study.
Sections du résumé
BACKGROUND
BACKGROUND
Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality.
METHODS
METHODS
We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk.
FINDINGS
RESULTS
Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% (
INTERPRETATION
CONCLUSIONS
Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk.
FUNDING
BACKGROUND
No funding was obtained for this study.
Identifiants
pubmed: 34585129
doi: 10.1016/j.eclinm.2021.101139
pii: S2589-5370(21)00419-3
pmc: PMC8461367
doi:
Types de publication
Journal Article
Langues
eng
Pagination
101139Subventions
Organisme : AHRQ HHS
ID : R01 HS026732
Pays : United States
Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
Dr. Tignanelli has a relationship (contract/grant) with the Gates Foundation and Minnesota Partnerships to conduct randomized controlled trial(s) of Losartan in COVID-19, outside the submitted work. Dr. Haslbauer and Dr. Tzankov received funding support from the Botnar Research Centre for Child Health Foundation Research Grant on COVID-19 for all their COVID-19 related research, outside the submitted research. Dr. Lutsey received NIH grants outside the submitted work. Dr. Shah received a MHealth Fairview Learning health system K12 grant, travel award for HTRS colloquium and ASH Medical educator institute award, and has a ASH system-based hematology committee leadership role. All theother authors have nothing to disclose
Références
N Engl J Med. 2020 Aug 6;383(6):590-592
pubmed: 32402155
Thromb Res. 2019 Sep;181:77-83
pubmed: 31376606
BMJ Open. 2020 Apr 8;10(4):e034778
pubmed: 32273316
N Engl J Med. 2020 Mar 19;382(12):1177-1179
pubmed: 32074444
Anesth Analg. 2021 Apr 1;132(4):930-941
pubmed: 33093359
Cell Res. 2020 May;30(5):367-369
pubmed: 32346073
Lancet Respir Med. 2020 Jun;8(6):544-546
pubmed: 32380023
Thromb Haemost. 2020 Dec;120(12):1691-1699
pubmed: 33186991
J Thromb Haemost. 2020 Oct;18(10):2640-2645
pubmed: 33448631
Clin Chem Lab Med. 2020 Jun 25;58(7):1116-1120
pubmed: 32172226
Nat Rev Immunol. 2020 Jun;20(6):363-374
pubmed: 32346093
J Am Heart Assoc. 2019 Sep 3;8(17):e012646
pubmed: 31441364
Cell Mol Immunol. 2016 Jul;13(4):432-42
pubmed: 27041635
Eur J Intern Med. 2020 Jul;77:158-160
pubmed: 32564905
J Am Heart Assoc. 2021 Apr 20;10(8):e018624
pubmed: 33550816
Circulation. 2016 Feb 9;133(6):601-9
pubmed: 26858290
Chest. 2016 Feb;149(2):315-352
pubmed: 26867832
Infect Dis Ther. 2020 Sep;9(3):573-586
pubmed: 32725536
J Am Coll Cardiol. 2020 Jul 7;76(1):122-124
pubmed: 32387623
N Engl J Med. 2021 Aug 26;385(9):790-802
pubmed: 34351721
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
J Infect. 2020 Aug;81(2):e16-e25
pubmed: 32335169
Blood. 2019 Feb 28;133(9):906-918
pubmed: 30642917
J Gen Intern Med. 2021 May 18;:
pubmed: 34003427
J Med Virol. 2020 Oct;92(10):1875-1883
pubmed: 32441789
N Engl J Med. 2020 Jul 9;383(2):120-128
pubmed: 32437596
J Thromb Haemost. 2020 Jul;18(7):1743-1746
pubmed: 32320517
J Am Coll Cardiol. 2020 Oct 20;76(16):1815-1826
pubmed: 32860872
J Thromb Thrombolysis. 2020 Jul;50(1):211-216
pubmed: 32451823
Thromb Res. 2020 Jul;191:148-150
pubmed: 32381264
Res Pract Thromb Haemost. 2020 Jun 12;4(4):510-517
pubmed: 32542211
J Thromb Haemost. 2017 Apr;15(4):744-757
pubmed: 28092405
J Thromb Haemost. 2020 Apr;18(4):844-847
pubmed: 32073213
Histopathology. 2020 Aug;77(2):198-209
pubmed: 32364264
J Thromb Haemost. 2020 Nov;18(11):2958-2967
pubmed: 32888372
PLoS One. 2021 Mar 31;16(3):e0248956
pubmed: 33788884
Am J Cardiovasc Drugs. 2020 Apr;20(2):199-207
pubmed: 31523759
J Thromb Haemost. 2018 Feb;16(2):231-241
pubmed: 29193703
PLoS Med. 2021 Mar 4;18(3):e1003553
pubmed: 33661905
J Thromb Haemost. 2020 Sep;18(9):2103-2109
pubmed: 32558075
Ann Intern Med. 2020 Aug 18;173(4):268-277
pubmed: 32374815
Diabetes Metab Res Rev. 2021 May 20;:e3476
pubmed: 34018307
N Engl J Med. 2021 Aug 26;385(9):777-789
pubmed: 34351722
JAMA. 2021 Apr 27;325(16):1620-1630
pubmed: 33734299
J Thromb Haemost. 2020 May;18(5):1094-1099
pubmed: 32220112
Lancet. 2021 Jun 12;397(10291):2253-2263
pubmed: 34097856
Lancet. 2008 Feb 2;371(9610):387-94
pubmed: 18242412
Med Care. 2017 Jul;55(7):698-705
pubmed: 28498196
J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
pubmed: 24685669
Cell Res. 2019 Sep;29(9):711-724
pubmed: 31399697
BMJ. 2021 Feb 11;372:n311
pubmed: 33574135
Blood. 2020 Jul 23;136(4):489-500
pubmed: 32492712