Background Mortality in coronavirus disease of 2019 (COVID-19) is associated with increases in prothrombotic parameters, particularly D-dimer levels. Anticoagulation has been proposed as therapy to decrease mortality, often adjusted for illness severity. Objective We wanted to investigate whether anticoagulation improves survival in COVID-19 and if this improvement in survival is associated with disease severity. Methods This is a cohort study simulating an intention-to-treat clinical trial, by analyzing the effect on mortality of anticoagulation therapy chosen in the first 48 hours of hospitalization. We analyzed 3,625 COVID-19+ inpatients, controlling for age, gender, glomerular filtration rate, oxygen saturation, ventilation requirement, intensive care unit admission, and time period, all determined during the first 48 hours. Results Adjusted logistic regression analyses demonstrated a significant decrease in mortality with prophylactic use of apixaban (odds ratio [OR] 0.46, p = 0.001) and enoxaparin (OR = 0.49, p = 0.001). Therapeutic apixaban was also associated with decreased mortality (OR 0.57, p = 0.006) but was not more beneficial than prophylactic use when analyzed over the entire cohort or within D-dimer stratified categories. Higher D-dimer levels were associated with increased mortality (p < 0.0001). When adjusted for these same comorbidities within D-dimer strata, patients with D-dimer levels < 1 µg/mL did not appear to benefit from anticoagulation while patients with D-dimer levels > 10 µg/mL derived the most benefit. There was no increase in transfusion requirement with any of the anticoagulants used. Conclusion We conclude that COVID-19+ patients with moderate or severe illness benefit from anticoagulation and that apixaban has similar efficacy to enoxaparin in decreasing mortality in this disease.

Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has a variable clinical course with significant mortality. Early reports suggested higher rates of SARS‐CoV‐2 infection in patients with type A blood and enrichment of type A individuals among COVID‐19 mortalities. Study Design and Methods The study includes all patients hospitalized or with an emergency department (ED) visit who were tested for SARS‐CoV‐2 between March 10, 2020 and June 8, 2020 and had a positive test result by nucleic acid test (NAT) performed on a nasopharyngeal swab specimen. A total of 4968 patients met the study inclusion criteria, with a subsequent 23.1% (n = 1146/4968) all‐cause mortality rate in the study cohort. To estimate overall risk by ABO type and account for the competing risks of in‐hospital mortality and discharge, we calculated the cumulative incidence function (CIF) for each event. Cause‐specific hazard ratios (csHRs) for in‐hospital mortality and discharge were analyzed using multivariable Cox proportional hazards models. Results Type A blood was associated with the increased cause‐specific hazard of death among COVID‐19 patients compared to type O (HR = 1.17, 1.02–1.33, p = .02) and type B (HR = 1.32,1.10–1.58, p = .003). Conclusions Our study shows that ABO histo‐blood group type is associated with the risk of in‐hospital death in COVID‐19 patients, warranting additional inquiry. Elucidating the mechanism behind this association may reveal insights into the susceptibility and/or immunity to SARS‐CoV‐2.

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