Department of Internal Medicine, Saint Joseph Mercy Oakland Hospital, Pontiac, MI.
Department of Internal Medicine, Mercy Health Muskegon, Muskegon, MI; and.
Am J Ther. 2021 Nov 26;29(1):e43-e49. doi: 10.1097/MJT.0000000000001462.
Therapeutic doses of anticoagulation have been administered to patients with coronavirus-19 disease (Covid-19) without thromboembolism, although there is a lack of robust evidence supporting this practice.
To compare outcomes between patients admitted to the hospital for Covid-19 who received full-dose anticoagulation purely for the indication of Covid-19 and patients who received prophylactic doses of anticoagulation.
This is a multicenter retrospective cohort study, including 7 community hospitals in Michigan. Patients were >18 years of age, confirmed positive for Covid-19 by polymerase chain reaction, and admitted to the hospital between March 10 and May 3, 2020. Exposed group: Patients receiving therapeutic dose anticoagulation for Covid-19 for any duration excluding clinically evident venous thromboembolism, atrial fibrillation, and myocardial infarction; control group: Patients receiving prophylactic anticoagulation. Propensity score matching was used to adjust for the nonrandomized nature of the study.
The primary endpoint: 30-day in-hospital mortality. Secondary endpoints: intubation, length of hospital stay, and readmissions in survivors.
A total of 115 exposed and 115 control patients were analyzed. Rates of 30-day in-hospital mortality were similar (exposed: 33.0% vs. control: 28.7%). Controlling for institution, there was no significant association between treatment and 30-day in-hospital mortality (hazard ratio: 0.63; 95% confidence interval: 0.37-1.06). Survivors had statistically similar length of hospital stay and readmission rates.
We found no difference in mortality in patients with Covid-19 without clinically evident venous thromboembolism, atrial fibrillation, and myocardial infarction who received therapeutic versus prophylactic doses of anticoagulation.
尽管缺乏强有力的证据支持，但已经向没有血栓栓塞的冠状病毒 19 型疾病（Covid-19）患者给予了治疗剂量的抗凝治疗。
比较因 Covid-19 住院且接受全剂量抗凝治疗单纯因 Covid-19 指征与接受预防性剂量抗凝治疗的患者的结局。
这是一项多中心回顾性队列研究，包括密歇根州的 7 家社区医院。患者年龄>18 岁，通过聚合酶链反应确诊为 Covid-19 阳性，并于 2020 年 3 月 10 日至 5 月 3 日住院。暴露组：因任何持续时间的 Covid-19 接受治疗剂量抗凝治疗的患者，不包括临床明显的静脉血栓栓塞、心房颤动和心肌梗死；对照组：接受预防性抗凝治疗的患者。采用倾向评分匹配来调整研究的非随机性。
主要终点：30 天院内死亡率。次要终点：插管、住院时间和幸存者再入院。
共分析了 115 名暴露组和 115 名对照组患者。30 天院内死亡率相似（暴露组：33.0%vs.对照组：28.7%）。控制机构后，治疗与 30 天院内死亡率之间无显著关联（风险比：0.63；95%置信区间：0.37-1.06）。幸存者的住院时间和再入院率统计学上相似。
我们发现，在没有临床明显静脉血栓栓塞、心房颤动和心肌梗死的 Covid-19 患者中，接受治疗剂量与预防性剂量抗凝治疗的患者死亡率无差异。
