Prior use of therapeutic anticoagulation does not protect against COVID-19 related clinical outcomes in hospitalized patients: a propensity score-matched cohort study

Abstract

The hypercoagulable state observed in COVID-19 could be responsible for morbidity and mortality. In this retrospective study we investigated whether therapeutic anticoagulation prior to infection has a beneficial effect in hospitalized COVID-19 patients. 1154 COVID-19 patients admitted to 6 hospitals in the Netherlands between March and May 2020 were included. We applied 1:3 propensity score matching to evaluate the association between prior therapeutic anticoagulation use and clinical outcome, with in hospital mortality as primary endpoint. 190 (16%) patients used therapeutic anticoagulation prior to admission. In the propensity score matched analyses, we observed no associations between prior use of therapeutic anticoagulation and overall mortality (RR 1.02 (95% CI; 0.80-1.30) or length of hospital stay (7.0 [4-12] vs 7.0 {4-12] days, p=0.69), although we observed a lower risk of pulmonary embolism (RR 0.19 (95% CI; 0.05-0.80). This study shows that prior use of therapeutic anticoagulation is not associated with improved clinical outcome in hospitalized COVID-19 patients.

COVID-19-associated coagulopathy and antithrombotic agents—lessons after 1 year

“…Inconsistent results on the association between use of chronic therapeutic anticoagulation and outcome in COVID-19 have been published, probably because of the dissimilar cohorts and improper correction of imbalances in baseline characteristics, including comorbidities. [33][34][35] In propensity score-matched comparisons, 36,37 there were no statistically significant differences in mortality, time to mechanical ventilation, or length of hospital stay in patients who received and those who did not receive chronic anticoagulatory therapy (some of these data have been published in a preprint and have not been peer reviewed). 37 Additionally, several small case series describe major bleeding complications in patients with COVID-19 who received intermediate dosed thromboprophylaxis.…”

“…[33][34][35] In propensity score-matched comparisons, 36,37 there were no statistically significant differences in mortality, time to mechanical ventilation, or length of hospital stay in patients who received and those who did not receive chronic anticoagulatory therapy (some of these data have been published in a preprint and have not been peer reviewed). 37 Additionally, several small case series describe major bleeding complications in patients with COVID-19 who received intermediate dosed thromboprophylaxis. [38][39][40] These findings under pinned the need for well designed and large randomised controlled trials on the efficacy and safety of anticoagulant treatment in patients with COVID-19.…”

“…In response to the observed thrombotic complications, several retrospective studies [33][34][35][36][37][38][39][40] have provided observational evidence on the potential benefit of therapeutic anticoagulant treatment in patients with COVID-19.…”

Clinical outcomes and the impact of prior oral anticoagulant use in patients with coronavirus disease 2019 admitted to hospitals in the UK — a multicentre observational study

“…Results from previous studies investigating the role of OACs prior to admission in patients with COVID‐19 have varied 13–19 Table IV. provides a summary of these studies.…”

Targeting SARS-CoV-2-Platelet Interactions in COVID-19 and Vaccine-Related Thrombosis

“…However, it soon became clear that patients continued to have thrombotic events on prophylactic heparin ( Trimaille et al, 2020 ) and some studies suggested that using intermediate dose heparin was more effective ( Stessel et al, 2020 ; Meizlish et al, 2021a ) although other studies showed no benefit from the increased dose of heparin ( Investigators, 2021 ). One study found that therapeutic anti-coagulation in COVID-19 patients reduced the risk of pulmonary embolism but had no effect on mortality ( Spiegelenberg et al, 2021 ).…”