Dataset Information

Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19.

ABSTRACT:

Background

Thromboembolic disease is common in coronavirus disease-2019 (COVID-19). There is limited evidence on the association of in-hospital anticoagulation (AC) with outcomes and postmortem findings.

Objectives

The purpose of this study was to examine association of AC with in-hospital outcomes and describe thromboembolic findings on autopsies.

Methods

This retrospective analysis examined the association of AC with mortality, intubation, and major bleeding. Subanalyses were also conducted on the association of therapeutic versus prophylactic AC initiated ?48 h from admission. Thromboembolic disease was contextualized by premortem AC among consecutive autopsies.

Results

Among 4,389 patients, median age was 65 years with 44% women. Compared with no AC (n = 1,530; 34.9%), therapeutic AC (n = 900; 20.5%) and prophylactic AC (n = 1,959; 44.6%) were associated with lower in-hospital mortality (adjusted hazard ratio [aHR]: 0.53; 95% confidence interval [CI]: 0.45 to 0.62 and aHR: 0.50; 95% CI: 0.45 to 0.57, respectively), and intubation (aHR: 0.69; 95% CI: 0.51 to 0.94 and aHR: 0.72; 95% CI: 0.58 to 0.89, respectively). When initiated ?48 h from admission, there was no statistically significant difference between therapeutic (n = 766) versus prophylactic AC (n = 1,860) (aHR: 0.86; 95% CI: 0.73 to 1.02; p = 0.08). Overall, 89 patients (2%) had major bleeding adjudicated by clinician review, with 27 of 900 (3.0%) on therapeutic, 33 of 1,959 (1.7%) on prophylactic, and 29 of 1,530 (1.9%) on no AC. Of 26 autopsies, 11 (42%) had thromboembolic disease not clinically suspected and 3 of 11 (27%) were on therapeutic AC.

Conclusions

AC was associated with lower mortality and intubation among hospitalized COVID-19 patients. Compared with prophylactic AC, therapeutic AC was associated with lower mortality, although not statistically significant. Autopsies revealed frequent thromboembolic disease. These data may inform trials to determine optimal AC regimens.

SUBMITTER: Nadkarni GN

PROVIDER: S-EPMC7449655 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Publications

Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19.

Nadkarni Girish N GN Lala Anuradha A Bagiella Emilia E Chang Helena L HL Moreno Pedro R PR Pujadas Elisabet E Arvind Varun V Bose Sonali S Charney Alexander W AW Chen Martin D MD Cordon-Cardo Carlos C Dunn Andrew S AS Farkouh Michael E ME Glicksberg Benjamin S BS Kia Arash A Kohli-Seth Roopa R Levin Matthew A MA Timsina Prem P Zhao Shan S Fayad Zahi A ZA Fuster Valentin V

Journal of the American College of Cardiology 20200826 16

<h4>Background</h4>Thromboembolic disease is common in coronavirus disease-2019 (COVID-19). There is limited evidence on the association of in-hospital anticoagulation (AC) with outcomes and postmortem findings.<h4>Objectives</h4>The purpose of this study was to examine association of AC with in-hospital outcomes and describe thromboembolic findings on autopsies.<h4>Methods</h4>This retrospective analysis examined the association of AC with mortality, intubation, and major bleeding. Subanalyses ...[more]

PMID: 32860872

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Project description:ImportanceVenous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality.ObjectiveTo characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality.Design, setting, and participantsThis cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients hospitalized between March 7, 2020, and June 17, 2020. Data were analyzed through March 2021.ExposuresNonadherence to VTE prophylaxis (defined as missing ≥2 days of VTE prophylaxis) and receipt of treatment-dose or prophylactic-dose anticoagulants vs no anticoagulation during hospitalization.Main outcomes and measuresThe effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality was assessed using multinomial logit models with inverse probability of treatment weighting.ResultsOf a total 1351 patients with COVID-19 included (median [IQR] age, 64 [52-75] years; 47.7% women, 48.9% Black patients), only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.61 per week). Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35).Conclusions and relevanceThis large, multicenter cohort of patients hospitalized with COVID-19, found evidence of rapid dissemination and implementation of anticoagulation strategies, including use of treatment-dose anticoagulation. As only prophylactic-dose anticoagulation was associated with lower 60-day mortality, prophylactic dosing strategies may be optimal for patients hospitalized with COVID-19.

Dataset Information

Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19.

Background

Objectives

Methods

Results

Conclusions

Publications

Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19.

Similar Datasets

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