31 Aug Anticoagulation, Mortality, Bleeding and Pathology Among Patients Hospitalized with COVID-19: A Single Health System Study
Girish N. Nadkarni, Anuradha Lala, Emilia Bagiella, Helena L. Chang, Pedro Moreno, Elisabet Pujadas, Varun Arvind, Sonali Bose, Alexander W. Charney, Martin D. Chen, Carlos Cordon-Cardo, Andrew S. Dunn, Michael E Farkouh, Benjamin Glicksberg, Arash Kia, Roopa Kohli-Seth, Matthew A. Levin, Prem Timsina, Shan Zhao, Zahi A. Fayad and Valentin Fuster
ABSTRACT
Background: Thromboembolic disease is common in coronavirus disease 19 (COVID-19). There is limited evidence on the association of in-hospital anticoagulation (AC) with outcomes and findings. postmortem.
Objective: To examine the association of CA with hospital outcomes and describe thromboembolic findings at autopsy.
Methods: Retrospective analysis that examined the association of CA with mortality, intubation and major bleeding. A subanalysis was also performed on the association of AC treatment versus prophylactic treatment initiated ≤48 hours from admission. Thromboembolic disease is described contextualized by pre-mortem CA between consecutive autopsies.
Results: 4.389 patients, with an average age of 65 years and 44% women. Compared to no AC (n = 1530, 34,9%):
- AC (n = 900, 20,5%) and prophylactic (n = 1959, 44,6%) treatment were associated with lower in-hospital mortality (adjusted hazard ratio [aHR] = 0,53; 95% CI: 0,45-0,62 and aHR = 0,50; 95% CI: 0,45-0,57, respectively) and intubation (aHR 0,69; 95% CI: 0,51-0,94 and aHR 0,72; 95% CI: 0,58-0,89, respectively).
- When initiated ≤48 hours from admission, there was no statistically significant difference between therapeutic (n = 766) versus prophylactic (n = 1860) CA (aHR 0,86, 95% CI: 0,73-1,02 ; p = 0,08).
- Overall, 89 patients (2%) had major bleeding adjudicated by medical review, with 27/900 (3,0%) on treatment, 33/1959 (1,7%) on prophylaxis, and 29/1,530 (1,9% ) without AC.
- Of 26 autopsies, 11 (42%) had clinically unsuspected thromboembolic disease and 3/11 (27%) were on therapeutic AC.
Conclusions: AC was associated with lower mortality and intubation among hospitalized patients with COVID-19. Compared with prophylactic AC, therapeutic AC was associated with lower mortality, although not statistically significant. Autopsies revealed frequent thromboembolic disease. These data may help further studies to determine optimal AC regimens.