Systemic Anticoagulation Associated with Improved Outcomes in COVID-19 Patients

Treatment with systemic coagulation may improve outcomes in patients with coronavirus disease 2019 (COVID-19), according to new research published in the Journal of the American College of Cardiology.

Investigators analyzed the association between anticoagulation treatments administered to hospitalized patients and mortality. They adjusted for age, sex, ethnicity, history of hypertension, heart failure, atrial fibrillation, type 2 diabetes, anticoagulation use prior to hospitalization, and admission date.

Nearly 30% of the 2773 patients with COVID-19 received systemic coagulation during their time in the hospital. The median length of stay was 5 days, and the median time from admission to anticoagulation treatment initiation was 2 days. The median treatment time with anticoagulation was 3 days.

Among the patients who received anticoagulation treatment during their time in the hospital, in-hospital mortality was 22.5% with a median survival of 21 days, compared with a mortality rate of 22.8% and a median survival of 14 days among patients who did not receive the therapy.

Notably, the investigators did find that patients who received anticoagulation were more likely to require mechanical ventilation (29.8% vs 8.1%). The in-hospital mortality rate for patients requiring ventilation and receiving anticoagulation was 29.1%, with a median survival of 21 days. For patients requiring ventilation who did not receive anticoagulation, the in-hospital mortality rate was 62.7% with a median survival of 9 days.

Furthermore, longer periods of anticoagulation treatment were associated with a reduced mortality risk, with an adjusted hazard ratio of 0.86 per day.

Although the researchers did find significant possible benefits, they also noted that these should be weighed against the risks. In the study, 3% of patients who received anticoagulation had bleeding events, compared with 1.9% of patients who were not on anticoagulation therapy. Bleeding events were also more common among patients who were intubated compared with non-intubated patients, at 7.5% and 1.35%, respectively.

REFERENCE

Anticoagulation Associated With Improved Outcomes in Hospitalized COVID-19 Patients [news release]. American College of Cardiology; https://www.acc.org/latest-in-cardiology/articles/2020/05/05/14/38/anticoagulation-associated-with-improved-outcomes-in-hospitalized-covid-19. Accessed May 20, 2020.