Association between pre‐admission anticoagulation and in‐hospital death, venous thromboembolism, and major bleeding among hospitalized COVID‐19 patients in Japan

Abstract

Purpose: The coagulation activation leads to thrombotic complications such as venous thromboembolism (VTE) in patients with coronavirus disease-2019 . Prophylactic anticoagulation therapy has been recommended for hospitalized COVID-19 patients in clinical guidelines. This retrospective cohort study aimed to examine the association between pre-admission anticoagulation treatment and three outcomes: in-hospital death, VTE, and major bleeding among hospitalized COVID-19 patients in Japan.Methods: Using a large-scale claims database built by the Medical Data Vision Co. in Japan, we identified patients hospitalized for COVID-19 who had outpatient prescription data at least once within 3 months before being hospitalized. Exposure was set as pre-admission anticoagulation treatment (direct oral anticoagulant or vitamin K antagonist), and outcomes were in-hospital death, VTE, and major bleeding. We conducted multivariable logistic regression analyses, adjusting for a single summarized score (a propensity score of receiving pre-admission anticoagulation) for VTE and major bleeding, due to the small number of outcomes.Results: Among the 2612 analytic patients, 179 (6.9%) had pre-admission anticoagulation. Crude incidence proportions were 13.4% versus 8.5% for in-hospital

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“…The association between COVID-19 and atrial fibrillation (AF) has been well reported, 25 , 26 , 27 COVID-19 patients with AF have also been characterized by old age, 28 which might be partly associated with the clinical features of patients receiving anticoagulants at therapeutic doses. Although no association has been reported between preadmission anticoagulation therapy and clinical outcomes, 29 these clinical features could exert some influence on clinical outcomes. The current study also showed that therapeutic-dose anticoagulants were used more often in patients with a more severe COVID-19 status at admission.…”

“…Previous reports have shown that the incidence of thrombosis in Japanese COVID-19 patients ranges from 1.8% to 5.3%, 31 , 32 , 33 whereas a meta-analysis from overseas reported a rate of 17%. The incidence of major bleeding is reported to be 2.2% to 2.9% in Japan, 29 , 32 and overseas meta-analyses report a rate of 3.9%. 32 Of these patients, 4.4% had major bleeding without pharmacological thromboprophylaxis, and 21.4% had major bleeding with therapeutic doses of anticoagulants.…”

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“…This database contains the patient demographics, date of admission/discharge, baseline comorbidities/ in-hospital complications, procedural/prescription records, and discharge status (death or survival). This database has been widely used in previous studies, including those on COVID-19 (20)(21)(22). Information on outpatient diagnoses and prescriptions was available if the patient was admitted to the hospital where she or he was seen as an outpatient.…”