Motta Jishu Kaul, Ogunnaike Rahila O, Shah Rutvik, Stroever Stephanie, Cedeño Harold V, Thapa Shyam K, Chronakos John J, Jimenez Eric J, Petrini Joann, Hegde Abhijith
Department of Medicine, Danbury Hospital, Danbury, CT.
Department of Research and Innovation, Danbury Hospital/ Nuvance Health Network, Danbury, CT.
Crit Care Explor. 2020 Dec 16;2(12):e0309. doi: 10.1097/CCE.0000000000000309. eCollection 2020 Dec.
To determine the impact of anticoagulation on inhospital mortality among coronavirus disease 2019-positive patients with the a priori hypothesis that there would be a lower risk of inhospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin.
Retrospective cohort study from April 1, 2020, to April 25, 2020. The date of final follow-up was June 12, 2020 Two large, acute-care hospitals in Western Connecticut.
Five hundred and one inpatients were identified after discharge as 18 years or older and positive for severe acute respiratory syndrome coronavirus 2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, whereas the clinical variables were abstracted from patients' medical records.
Preemptive enoxaparin or heparin at a therapeutic or prophylactic dose.
When comparing treatments through multivariable analysis, risk of inhospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0-4.9; = 0.04). Additionally, the average treatment effects were higher (β = 0.11, = 0.01) in the therapeutic group.
An increase in inhospital mortality was observed among patients on preemptive therapeutic anticoagulation. Thus, in the management of coronavirus disease 2019 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.
确定抗凝治疗对2019冠状病毒病阳性患者住院死亡率的影响，预先假设与预防性剂量的依诺肝素或肝素相比，采用抢先治疗性抗凝可降低住院死亡风险。
2020年4月1日至2020年4月25日的回顾性队列研究。最终随访日期为2020年6月12日，位于康涅狄格州西部的两家大型急症医院。
出院后确定501名18岁及以上的住院患者，严重急性呼吸综合征冠状病毒2检测呈阳性。应用排除标准后，最终样本量为374例患者。人口统计学变量通过医院账单查询收集，而临床变量则从患者病历中提取。
治疗剂量或预防剂量的抢先使用依诺肝素或肝素。
通过多变量分析比较治疗方法时，接受抢先治疗性抗凝的患者住院死亡风险高2.3倍（95%CI = 1.0 - 4.9；P = 0.04）。此外，治疗组的平均治疗效果更高（β = 0.11，P = 0.01）。
观察到抢先治疗性抗凝患者的住院死亡率有所增加。因此，在2019冠状病毒病及其并发症的管理中，我们建议进一步研究并谨慎使用抢先治疗性抗凝而非预防性抗凝。
