01 September 2020

Hospitalised COVID-19 patients who are treated with anticoagulants have a better chance of survival than others, a new study shows.

The observational study, published in the Journal of the American College of Cardiology, follows earlier research by the team at Mount Sinai Hospital, New York, USA, which showed that anticoagulation therapy was associated with improved survival among the patients.

This follow up Mount Sinai study found that patients on either a therapeutic or prophylactic dose had about a 50% lower chance of death and about a 30% lower chance of intubation, compared with those who were not treated with anticoagulants.

The research team evaluated the electronic medical records of 4,389 confirmed COVID-19 patients admitted during March and April 2020 to five Mount Sinai hospitals across New York.

They examined six anticoagulant regimens, specifically analysing survival and death rates for patients placed on therapeutic and prophylactic doses of oral antithrombotics, subcutaneous heparin, and intravenous heparin, compared with those not treated with blood thinners.

They went on to use hazard scores to estimate risk of death, which took relevant risk factors into account, including age, ethnicity, pre-existing conditions, and whether the patient was already on blood thinners. The researchers also corrected for disease severity, including low oxygen saturation levels and intubation.

Of all the patients analysed, 900 (20.5%) received a higher therapeutic dose of anticoagulants, while another 1,959 patients (44.6%) received a lower prophylactic dose. The remaining 1,530 patients (34.9%) were not treated with blood thinners.

The researchers found that both therapeutic and prophylactic doses of anticoagulants reduced mortality by about half compared to patients on no blood thinners.

Overall, 467 (10.6%) of the patients required intubation and mechanical ventilation during their hospitalisation. Those being treated with blood thinners had 31% fewer intubations than those who were not treated with them, while those on prophylactic blood thinners had 28% fewer intubations.

Bleeding event rates were low at 3% or less among all patients, but slightly higher in the therapeutic group compared to the prophylactic and no-blood-thinner groups, the researchers said.

They add that their findings suggest clinicians should evaluate patients on an individual basis, and that therapeutic and prophylactic subcutaneous low-molecular weight heparin, and therapeutic oral apixaban may lead to better results.

Senior corresponding author Dr Valentin Fuster said the additional information gathered on the role of anticoagulation in the management of hospital patients with COVID-19 has helped the team to design a large-scale international clinical trial.

Corresponding author Dr Anu Lala added: “This report is much more in-depth than our previous brief report and includes many more patients, longer follow-up, and rigorous methodology. Clearly, anticoagulation is associated with improved outcomes and bleeding rates appear to be low.”

First author Dr Girish Nadkarni said: “We are excited that results from this observational study in one of the largest and most diverse hospitalised populations have led to an ongoing trial of type, duration, and doses of anticoagulation. Ultimately we hope this work will lead to improved outcomes and treatment for COVID-19 patients.”

Source: Nadkarni GN, Lala A, Bagiella E, Chang HL, Moreno P, Pujadas E, Arvind V, Bose S, Charney AW, Chen MD, Cordon-Cardo C, Dunn AS, Farkouh ME, Glicksberg B, Kia A, Kohli-Seth R, Levin MA, Timsina P, Zhao S, Fayad ZA, Fuster V. (2020) “Anticoagulation, Mortality, Bleeding and Pathology Among Patients Hospitalized with COVID-19: A Single Health System Study.” Journal of the American College of Cardiology, doi: 10.1016/j.jacc.2020.08.041


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