Roomi Sohaib Sanan, Saddique Maryum, Ullah Waqas, Haq Shujaul, Ashfaq Ammar, Madara John, Boigon Margot
Jefferson Health-Abington, Abington, PA, USA.
Einstein Health Care, Philadelphia, PA, USA.
J Community Hosp Intern Med Perspect. 2021 Jan 26;11(1):17-22. doi: 10.1080/20009666.2020.1835297.
COVID-19 induces a pro-thrombotic state as evidenced by microvascular thrombi in the renal and pulmonary vasculature. Therapeutic anticoagulation in COVID-19 has been debated and data remain anecdotal. We hypothesize that therapeutic anticoagulation is associated with a reduction in in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation, and acute renal failure necessitating dialysis by decreasing the over-all clot burden. A retrospective cohort study was done to determine the impact of therapeutic anticoagulation in hospitalized COVID-19 patients. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI) respectively. A total of 176 hospitalized COVID-19 patients were divided into two groups, therapeutic anticoagulation and prophylactic anticoagulation. The mean age, baseline comorbidities and other medications used during hospitalization were similar in both groups. The aOR for in-hospital mortality (OR 3.05, 95% CI 1.15-8.10, p = 0.04), upgrade to intensive care (OR 3.08, 95% CI 1.43-6.64, p = 0.006) and invasive mechanical ventilation (OR 4.27, 95% CI 1.95-9.34, p = 0.00) were significantly lower while there was no statistically significant difference in the rate of developing acute renal failure (OR 1.87 95% CI 0.46-7.63, p = 0.64) between two groups. In patients with COVID-19, therapeutic anticoagulation offers a significant reduction in the rate of in-hospital mortality, upgrade to intensive medical care, and invasive mechanical ventilation. It should be preferred over prophylactic anticoagulation in COVID-19 patients unless randomized controlled trials prove otherwise.
新型冠状病毒肺炎（COVID-19）可引发促血栓形成状态，肾和肺血管中的微血管血栓即为证据。COVID-19患者的治疗性抗凝一直存在争议，相关数据仍属轶事性。我们推测，治疗性抗凝可通过减轻总体血栓负荷，降低住院死亡率、转入重症监护病房、有创机械通气以及因急性肾衰竭而需透析的发生率。我们开展了一项回顾性队列研究，以确定治疗性抗凝对住院COVID-19患者的影响。分别进行独立t检验和多因素逻辑回归分析，以计算平均差异和调整后的优势比（aOR）及其95%置信区间（CI）。共有176例住院COVID-19患者被分为两组，即治疗性抗凝组和预防性抗凝组。两组患者的平均年龄、基线合并症以及住院期间使用的其他药物相似。治疗性抗凝组的住院死亡率（OR 3.05，95% CI 1.15 - 8.10，p = 0.04）、转入重症监护病房（OR 3.08，95% CI 1.43 - 6.64，p = 0.006）和有创机械通气（OR 4.27，95% CI 1.95 - 9.34，p = 0.00）的aOR显著更低，而两组间急性肾衰竭发生率（OR 1.87，95% CI 0.46 - 7.63，p = 0.64）无统计学显著差异。对于COVID-19患者，治疗性抗凝可显著降低住院死亡率、转入重症医疗护理和有创机械通气的发生率。除非随机对照试验另有证明，否则在COVID-19患者中，治疗性抗凝应优于预防性抗凝。
