Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19 : A propensity score-matched analysis
© 2021 Wiley Periodicals LLC..
Thrombotic complications occur at high rates in hospitalized patients with COVID-19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. We examined in-hospital mortality with intermediate- compared to prophylactic-dose anticoagulation, and separately with in-hospital aspirin compared to no antiplatelet therapy, in a large, retrospective study of 2785 hospitalized adult COVID-19 patients. In this analysis, we established two separate, nested cohorts of patients (a) who received intermediate- or prophylactic-dose anticoagulation ("anticoagulation cohort", N = 1624), or (b) who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy ("aspirin cohort", N = 1956). To minimize bias and adjust for confounding factors, we incorporated propensity score matching and multivariable regression utilizing various markers of illness severity and other patient-specific covariates, yielding treatment groups with well-balanced covariates in each cohort. The primary outcome was cumulative incidence of in-hospital death. Among propensity score-matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate- compared to prophylactic-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.518 [0.308-0.872]). Among propensity-score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in-hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.522 [0.336-0.812]). In this propensity score-matched, observational study of COVID-19, intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death.
| Errataetall: | |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:96 |
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| Enthalten in: |
American journal of hematology - 96(2021), 4 vom: 01. Apr., Seite 471-479 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Meizlish, Matthew L [VerfasserIn] |
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| Links: |
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| Themen: |
Anticoagulants |
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| Anmerkungen: |
Date Completed 22.03.2021 Date Revised 19.10.2023 published: Print-Electronic UpdateOf: medRxiv. 2021 Jan 15;:. - PMID 33469595 Citation Status MEDLINE |
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| doi: |
10.1002/ajh.26102 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320387151 |
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| 100 | 1 | |a Meizlish, Matthew L |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19 |b A propensity score-matched analysis |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 22.03.2021 | ||
| 500 | |a Date Revised 19.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a UpdateOf: medRxiv. 2021 Jan 15;:. - PMID 33469595 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 Wiley Periodicals LLC. | ||
| 520 | |a Thrombotic complications occur at high rates in hospitalized patients with COVID-19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. We examined in-hospital mortality with intermediate- compared to prophylactic-dose anticoagulation, and separately with in-hospital aspirin compared to no antiplatelet therapy, in a large, retrospective study of 2785 hospitalized adult COVID-19 patients. In this analysis, we established two separate, nested cohorts of patients (a) who received intermediate- or prophylactic-dose anticoagulation ("anticoagulation cohort", N = 1624), or (b) who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy ("aspirin cohort", N = 1956). To minimize bias and adjust for confounding factors, we incorporated propensity score matching and multivariable regression utilizing various markers of illness severity and other patient-specific covariates, yielding treatment groups with well-balanced covariates in each cohort. The primary outcome was cumulative incidence of in-hospital death. Among propensity score-matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate- compared to prophylactic-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.518 [0.308-0.872]). Among propensity-score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in-hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.522 [0.336-0.812]). In this propensity score-matched, observational study of COVID-19, intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death | ||
| 650 | 4 | |a Clinical Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
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| 650 | 7 | |a Aspirin |2 NLM | |
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| 700 | 1 | |a Goshua, George |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Yiwen |e verfasserin |4 aut | |
| 700 | 1 | |a Fine, Rebecca |e verfasserin |4 aut | |
| 700 | 1 | |a Amin, Kejal |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a DeFilippo, Nicholas |e verfasserin |4 aut | |
| 700 | 1 | |a Keating, Craig |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Yuxin |e verfasserin |4 aut | |
| 700 | 1 | |a Mankbadi, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a McManus, Dayna |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Stephen Y |e verfasserin |4 aut | |
| 700 | 1 | |a Price, Christina |e verfasserin |4 aut | |
| 700 | 1 | |a Bona, Robert D |e verfasserin |4 aut | |
| 700 | 1 | |a Ochoa Chaar, Cassius Iyad |e verfasserin |4 aut | |
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