Therapeutic Anticoagulation Delays Death in COVID-19 Patients: Cross-Sectional Analysis of a Prospective Cohort

Filip Ionescu; Giovi Grasso-Knight; Edward Castillo; Ehsun Naeem; Ioana Petrescu; Zaid Imam; Vishal K. Patel; Mangala Narasimhan; Girish B. Nair

doi:10.1055/s-0040-1716721

TH Open, Table of Contents

CC BY 4.0 · TH Open 2020; 04(03): e263-e270
DOI: 10.1055/s-0040-1716721

Original Article

Therapeutic Anticoagulation Delays Death in COVID-19 Patients: Cross-Sectional Analysis of a Prospective Cohort

Authors

Filip Ionescu

¹Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
Giovi Grasso-Knight

²Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
Edward Castillo

³Department of Radiation Oncology, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States

⁴Department of Computational and Applied Mathematics, Rice University, Texas, United States
Ehsun Naeem

¹Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
Ioana Petrescu

¹Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
Zaid Imam

¹Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
Vishal K. Patel

²Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
Mangala Narasimhan

⁵Division of Pulmonary and Critical Care Medicine, North Well, New York, New York, United States
Girish B. Nair

²Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States

Abstract

A hypercoagulable state has been described in coronavirus disease 2019 (COVID-19) patients. Others have reported a survival advantage with prophylactic anticoagulation (pAC) and therapeutic anticoagulation (tAC), but these retrospective analyses have important limitations such as confounding by indication. We studied the impact of tAC and pAC compared with no anticoagulation (AC) on time to death in COVID-19. We performed a cross-sectional analysis of 127 deceased COVID-19 patients and compared time to death in those who received tAC (n = 67), pAC (n = 47), and no AC (n = 13). Median time to death was longer with higher doses of AC (11 days for tAC, 8 days for pAC, and 4 days for no AC, p < 0.001). In multivariate analysis, AC was associated with longer time to death, both at prophylactic (hazard ratio [HR] = 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.001) and therapeutic doses (HR = 0.15; 95% CI: 0.07 to 0.32; p < 0.001) compared with no AC. Bleeding rates were similar among tAC and remaining patients (19 vs. 18%; p = 0.877). In deceased COVID-19 patients, AC was associated with a delay in death in a dose-dependent manner. Randomized trials are required to prospectively investigate the benefit and safety of higher doses of AC in this population.

Keywords

anticoagulation - COVID-19 - novel coronavirus - heparin

Full Text

References

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