Patel Niti G, Bhasin Ajay, Feinglass Joseph M, Angarone Michael P, Cohen Elaine R, Barsuk Jeffrey H
Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA.
Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL, USA.
Thromb Update. 2021;2:100027. doi: 10.1016/j.tru.2020.100027. Epub 2021 Mar 19.
COVID-19 is associated with hypercoagulability and increased incidence of thrombosis. We compared the clinical outcomes of adults hospitalized with COVID-19 who were on therapeutic anticoagulants to those on prophylactic anticoagulation.
We performed an observational study of adult inpatients' with COVID-19 from March 9 to June 26, 2020. We compared patients who were continued on their outpatient prescribed therapeutic anticoagulation and those who were newly started on therapeutic anticoagulation for COVID-19 (without other indication) to those who were on prophylactic doses. The primary outcome was overall death while secondary outcomes were critical illness (World Health Organization Ordinal Scale for Clinical Improvement score ≥5), mechanical ventilation, and death among patients who first had critical illness. We adjusted for age, sex, race, body mass index (BMI), Charlson score, glucose on admission, and use of antiplatelet agents.
Of 1716 inpatients with COVID-19, 171 patients were continued on their therapeutic anticoagulation and 78 were started on new therapeutic anticoagulation for COVID-19. In patients continued on home therapeutic anticoagulation, there were no differences in overall death, critical illness, mechanical ventilation, or death among patients with critical illness compared to patients on prophylactic anticoagulation. In patients receiving new therapeutic anticoagulation for COVID-19, there was increased death (OR 5.93; 95% CI 3.71-9.47), critical illness (OR 14.51; 95% CI 7.43-28.31), need mechanical ventilation (OR 11.22; 95% CI 6.67-18.86), and death after first having critical illness (OR 5.51; 95% CI 2.80-10.87).
Therapeutic anticoagulation for inpatients with COVID-19 was not associated with improved outcomes.
新型冠状病毒肺炎（COVID-19）与高凝状态及血栓形成发生率增加有关。我们比较了接受治疗性抗凝的COVID-19住院成人患者与接受预防性抗凝的患者的临床结局。
我们对2020年3月9日至6月26日的COVID-19成年住院患者进行了一项观察性研究。我们将继续接受门诊规定的治疗性抗凝治疗的患者、因COVID-19新开始接受治疗性抗凝治疗（无其他指征）的患者与接受预防性剂量抗凝治疗的患者进行了比较。主要结局是总体死亡，次要结局是危重症（世界卫生组织临床改善序数量表评分≥5）、机械通气以及首次发生危重症的患者中的死亡情况。我们对年龄、性别、种族、体重指数（BMI）、查尔森评分、入院时血糖以及抗血小板药物的使用情况进行了校正。
在1716例COVID-19住院患者中，171例继续接受治疗性抗凝治疗，78例因COVID-19开始新的治疗性抗凝治疗。在继续接受家庭治疗性抗凝治疗的患者中，与接受预防性抗凝治疗的患者相比，总体死亡、危重症、机械通气或危重症患者中的死亡情况均无差异。在因COVID-19接受新的治疗性抗凝治疗的患者中，死亡风险增加（比值比[OR]5.93；95%置信区间[CI]3.71 - 9.47）、危重症风险增加（OR 14.51；95% CI 7.43 - 28.31）、需要机械通气的风险增加（OR 11.22；95% CI 6.67 - 18.86）以及首次发生危重症后的死亡风险增加（OR 5.51；95% CI 2.80 - 10.87）。
COVID-19住院患者的治疗性抗凝治疗与改善结局无关。
