Impact of anticoagulation prior to COVID-19 infection: a propensity score–matched cohort study

Tremblay, Douglas; Gerwen, Maaike van; Alsen, Mathilda; Thibaud, Santiago; Kessler, Alaina J.; Venugopal, Sangeetha; Makki, Iman; Qin, Qian; Dharmapuri, Sirish; Jun, Tomi; Bhalla, Sheena; Berwick, Shana; Feld, Jonathan; Mascarenhas, John; Troy, Kevin; Cromwell, Caroline; Dunn, Andrew; Oh, William; Naymagon, Leonard

doi:10.1182/blood.2020006941

Cited by 139 publications

(218 citation statements)

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“…Given the strong procoagulant component that accompanies the pathophysiology of COVID-19, one hypothesis that has generated interest is whether being on anticoagulation for unrelated conditions prior to COVID-19 is protective for COVID-19 related outcomes. A recent propensity score-matched study compared 913 patients receiving anticoagulation (antiplatelet or anticoagulation therapy) with 2859 patients receiving neither at the time of COVID-19 diagnosis and found no statistically significant difference in survival, mechanical ventilation and need for hospital admission between both groups [25]. The uncertainty highlighted in observational studies and disagreement between guidelines re-iterates the importance of ongoing randomised trials such as COVID-HEP (NCT04345848) and REMAP-CAP [26].…”

Section: Discussionmentioning

confidence: 99%

“…A higher proportion of patients with thrombotic complications died when compared with those without but this was not statistically significant (32 (39.5%) vs. 27 (25.5%), p = 0.059). Median (IQR) ICU length of stay was longer in patients who developed thrombotic complications 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) days vs. 12 (7-13) days, p = 0.003).…”

Section: Mortalitymentioning

confidence: 99%

“…Time interval between ICU admission and bleeding episode (days), median (IQR)15(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) No. requiring red blood cell transfusion, n (%) 7 (46.7) SOFA score at time of bleed, median (IQR) 9 (5-12) Organ support requirement (n = 12), n Laboratory data at time of bleeding episode (n = 12) Platelet count (× 10 9 /L), median (IQR) 244 (163-325) Prothrombin time (seconds), median (IQR) 11.3 (10.6-11.8) Activate partial thromboplastin time (seconds), median (IQR) 27.2 (23.6-34.2) Fibrinogen (g/L), median (IQR) 4.8 (2.8-6.3) ICU length of stay (days), median (IQR) 20 (10-35) APACHE Acute Physiology and Chronic Health Evaluation, GU genitourinary, ICU intensive care unit, SOFA Sequential Organ Failure Assessment,…”

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confidence: 99%

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Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

et al. 2020

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Background Optimal prophylactic and therapeutic management of thromboembolic disease in patients with COVID-19 remains a major challenge for clinicians. The aim of this study was to define the incidence of thrombotic and haemorrhagic complications in critically ill patients with COVID-19. In addition, we sought to characterise coagulation profiles using thromboelastography and explore possible biological differences between patients with and without thrombotic complications. Methods We conducted a multicentre retrospective observational study evaluating all the COVID-19 patients received in four intensive care units (ICUs) of four tertiary hospitals in the UK between March 15, 2020, and May 05, 2020. Clinical characteristics, laboratory data, thromboelastography profiles and clinical outcome data were evaluated between patients with and without thrombotic complications. Results A total of 187 patients were included. Their median (interquartile (IQR)) age was 57 (49–64) years and 124 (66.3%) patients were male. Eighty-one (43.3%) patients experienced one or more clinically relevant thrombotic complications, which were mainly pulmonary emboli (n = 42 (22.5%)). Arterial embolic complications were reported in 25 (13.3%) patients. ICU length of stay was longer in patients with thrombotic complications when compared with those without. Fifteen (8.0%) patients experienced haemorrhagic complications, of which nine (4.8%) were classified as major bleeding. Thromboelastography demonstrated a hypercoagulable profile in patients tested but lacked discriminatory value between those with and without thrombotic complications. Patients who experienced thrombotic complications had higher D-dimer, ferritin, troponin and white cell count levels at ICU admission compared with those that did not. Conclusion Critically ill patients with COVID-19 experience high rates of venous and arterial thrombotic complications. The rates of bleeding may be higher than previously reported and re-iterate the need for randomised trials to better understand the risk-benefit ratio of different anticoagulation strategies. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

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Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

et al. 2020

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“…Ultimately, 8 studies were included in the final qualitative synthesis (Figure 1). [12][13][14][15][16][17][18][19][20] The main features of the 8 studies are presented in Table 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Wijaya

Andhika

Huang

2020

Clin Appl Thromb Hemost

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The incidence of venous thromboembolism (VTE) events in patients with COVID-19 treated with a standard thromboprophylaxis dose of anticoagulants remains high. We conducted a systematic review in order to explore the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19. A systematic search was carried out using the electronic databases of PubMed, EuropePMC, and the Cochrane Central Database, using specific keywords. All articles that fulfilled the inclusion criteria were included in the qualitative analysis. There were 8 observational studies included in the final qualitative analysis. Quality assessment using the Newcastle-Ottawa Scale (NOS) showed a mean score of 7.5 ± 1.06, indicating moderate to high quality of the studies. Three retrospective cohort studies reported a reduction in the mortality rate, while 6 other studies showed no mortality benefits among patients with COVID-19 treated with therapeutic-dose anticoagulation. There was a slight tendency toward a reduction in the mortality rate among mechanically-ventilated patients with COVID-19 receiving therapeutic-dose anticoagulation. Bleeding events and thrombotic complications among patients receiving therapeutic-dose anticoagulation were reported in 3 studies. Although it is too soon to draw any conclusions, this systematic review draws attention to current evidence regarding the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19.

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“…110,111 One study found no significant difference in outcomes, including mortality and mechanical ventilation; however, this study utilized a propensity-matched cohort, which limited the anticoagulation sample size to <150 patients and the authors do not clarify which anticoagulant was administered, if antiplatelets were given simultaneously, and there was no control for anticoagulation treatment regimen once admitted into the hospital. 110 The second study, also small with a patient population of 70, evaluated elderly patients with chronic heart disease that were on anticoagulants for at least 6 months prior to the diagnosis of COVID-19-related interstitial pneumonia and found that direct oral anticoagulants (DOACs), factor IIa and factor Xa inhibitors, appeared to be significantly protective. 111 Although this is an important study and a step in the right direction, the authors acknowledge that more thorough studies need to be performed.…”

Section: Factor Xa Inhibitors As a Potential Treatment For Covid-19mentioning

confidence: 96%

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2020

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Impact of anticoagulation prior to COVID-19 infection: a propensity score–matched cohort study

Cited by 139 publications

References 19 publications

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

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