Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia
Copyright © 2020 Elsevier Ltd. All rights reserved..
BACKGROUND: SARS-CoV-2 infection has noted derangements in coagulation markers along with significant thrombotic complications. Post-mortem examinations show severe endothelial injury and widespread thrombotic microangiopathy in the pulmonary vasculature. Early reports describing the use of prophylactic anticoagulation demonstrated improved survival, leading to the adoption of prophylactic and therapeutic anticoagulation guided by D-dimer levels. The clinical usefulness of D-dimer values, trends, and more intensive anticoagulation remains an area of clinical interest.
OBJECTIVES: Assess the outcomes and laboratory trends in COVID-19 patients stratified by intensity of anticoagulation at time of admission.
PATIENTS AND METHODS: Retrospectively review the differences in clinical outcomes and laboratory trends in patients hospitalized with COVID-19 in the Lifespan Health System.
RESULTS: Between 27 February and 24 April 2020, 468 patients were hospitalized. Initial use of high-intensity thromboprophylaxis was associated with improved 30-day mortality (adjusted RR 0.26; 95% confidence interval [CI], 0.07-0.97; p = 0.045) without a significant increased rate of bleeding (p = 0.11). In severe COVID-19, D-dimer significantly increased during hospitalization with standard thromboprophylaxis (p < 0.001) but remained stable or decreased with high-intensity prophylaxis or therapeutic anticoagulation.
CONCLUSION: Patients who received high-intensity prophylactic anticoagulation had a downtrend in D-dimer levels and improved 30-day mortality. This suggests a role in anticoagulation in mitigating adverse outcomes associated with COVID-19; however, further randomized, prospective studies are needed.
| Errataetall: |
CommentOn: Lancet. 2020 Feb 15;395(10223):497-506. - PMID 31986264 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:196 |
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| Enthalten in: |
Thrombosis research - 196(2020) vom: 15. Dez., Seite 375-378 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hsu, Andrew [VerfasserIn] |
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| Links: |
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| Themen: |
Anticoagulants |
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| Anmerkungen: |
Date Completed 04.12.2020 Date Revised 10.01.2021 published: Print-Electronic CommentOn: Lancet. 2020 Feb 15;395(10223):497-506. - PMID 31986264 Citation Status MEDLINE |
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| doi: |
10.1016/j.thromres.2020.09.030 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM31551339X |
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| 500 | |a Date Revised 10.01.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentOn: Lancet. 2020 Feb 15;395(10223):497-506. - PMID 31986264 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: SARS-CoV-2 infection has noted derangements in coagulation markers along with significant thrombotic complications. Post-mortem examinations show severe endothelial injury and widespread thrombotic microangiopathy in the pulmonary vasculature. Early reports describing the use of prophylactic anticoagulation demonstrated improved survival, leading to the adoption of prophylactic and therapeutic anticoagulation guided by D-dimer levels. The clinical usefulness of D-dimer values, trends, and more intensive anticoagulation remains an area of clinical interest | ||
| 520 | |a OBJECTIVES: Assess the outcomes and laboratory trends in COVID-19 patients stratified by intensity of anticoagulation at time of admission | ||
| 520 | |a PATIENTS AND METHODS: Retrospectively review the differences in clinical outcomes and laboratory trends in patients hospitalized with COVID-19 in the Lifespan Health System | ||
| 520 | |a RESULTS: Between 27 February and 24 April 2020, 468 patients were hospitalized. Initial use of high-intensity thromboprophylaxis was associated with improved 30-day mortality (adjusted RR 0.26; 95% confidence interval [CI], 0.07-0.97; p = 0.045) without a significant increased rate of bleeding (p = 0.11). In severe COVID-19, D-dimer significantly increased during hospitalization with standard thromboprophylaxis (p < 0.001) but remained stable or decreased with high-intensity prophylaxis or therapeutic anticoagulation | ||
| 520 | |a CONCLUSION: Patients who received high-intensity prophylactic anticoagulation had a downtrend in D-dimer levels and improved 30-day mortality. This suggests a role in anticoagulation in mitigating adverse outcomes associated with COVID-19; however, further randomized, prospective studies are needed | ||
| 650 | 4 | |a Letter | |
| 650 | 4 | |a Comment | |
| 650 | 4 | |a Anticoagulation | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a COVID-19 coagulopathy | |
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| 700 | 1 | |a Zayac, Adam S |e verfasserin |4 aut | |
| 700 | 1 | |a Olszewski, Adam J |e verfasserin |4 aut | |
| 700 | 1 | |a Reagan, John L |e verfasserin |4 aut | |
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