Clinical Outcomes in Hospitalized Patients with COVID-19 on Therapeutic Anticoagulants

Abstract

Background: COVID-19 is associated with hypercoagulability and an increased incidence of thrombosis. We evaluated the clinical outcomes of adults hospitalized with COVID-19 who either continued therapeutic anticoagulants previously prescribed or who were newly started on anticoagulants during hospitalization. Methods: We performed an observational study of adult inpatients with COVID-19 at 10 hospitals affiliated with Northwestern Medicine in the Chicagoland area from March 9 to June 26, 2020. We evaluated clinical outcomes of subjects with COVID-19 who were continued on their outpatient therapeutic anticoagulation during hospitalization and those who were newly started on these medications compared to those who were on prophylactic doses of these medications based on the World Health Organization (WHO) Ordinal Scale for Clinical Improvement. The primary outcome was overall death while secondary outcomes were critical illness (WHO score >5), need for mechanical ventilation, and death among those subjects who first had critical illness adjusted for age, sex, race, body mass index (BMI), Charlson score, glucose on admission, and use of antiplatelet agents. Results: 1,716 subjects with COVID-19 were included in the analysis. 171 subjects (10.0%) were continued on their outpatient therapeutic anticoagulation and 201(11.7%) were started on new therapeutic anticoagulation during hospitalization. In subjects continued on home therapeutic anticoagulation, there were no differences in overall death, critical illness, mechanical ventilation, or death among subjects with critical illness compared to subjects on prophylactic anticoagulation. Subjects receiving new therapeutic anticoagulation for COVID-19 were more likely to die (OR 5.93; 95% CI 3.71-9.47), have critical illness (OR 14.51; 95% CI 7.43-28.31), need mechanical ventilation (OR 11.22; 95% CI 6.67-18.86), and die after first having critical illness. (OR 5.51; 95% CI 2.80 -10.87). Conclusions: Continuation of outpatient prescribed anticoagulant was not associated with improved clinical outcomes. Therapeutic anticoagulation for COVID-19 in absence of other indications was associated with worse clinical outcomes.

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

“…Seven studies investigated the effect of age on the risk of intubation, using individuals hospitalized due to COVID-19. All studies were set in the USA (42, 55, 74, 82, 88, 91), and a summary of the results can be seen in Table S11. No studies had a low risk of bias (high quality), either due to the “confounding” or “exposure assessment” domain (Table S12).…”

Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence

“…By further restricting our analysis to age-adjusted estimates, we might have excluded evidence from countries that are now not otherwise represented in our review. Although 14 [138,145,149,171,198,207,218,232,241,259,265,273,288,293] of the primary studies in our selection have not yet been peer-reviewed (but were published on pre-print servers), they were included in our analyses to increase the evidence pool. These studies were reviewed and evaluated in the included systematic reviews; however, their inclusion might limit our work.…”

Structural Features and PF4 Functions that Occur in Heparin-Induced Thrombocytopenia (HIT) Complicated by COVID-19

“…Since elevated D-dimer levels are often found in patients with clotting problems, severe COVID-19 patients with elevated D-dimer levels are treated with unfractionated heparin or LMWH as an anticoagulation to reduce mortality ( Table 1 ) [ 82 , 83 , 84 , 85 , 86 , 87 ]. However, the current anticoagulation options have limited effect on thrombosis in general COVID-19 patients, and some of the observed effects were not significant [ 88 , 89 , 90 , 91 ]. In a Dutch study of COVID-19 patients, all 184 ICU patients received at least standard doses thromboprophylaxis, but thrombosis still occured in 31% patients, including 27% venous thromboembolism (VTE) and 3.7% arterial thrombotic events [ 92 ].…”