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Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: A propensity score-matched
Matthew L Meizlish1, George Goshua2, Yiwen Liu3
1Yale School of Medicine, New Haven, Connecticut, USA.
Insights
Intermediate-dose anticoagulation and aspirin significantly reduced in-hospital deaths for COVID-19 patients. This observational study highlights the benefits of these antithrombotic therapies in reducing mortality for hospitalized COVID-19 cases.
Area of Science:
- Internal Medicine
- Cardiology
- Infectious Diseases
Background:
- Hospitalized COVID-19 patients face high rates of thrombotic complications.
- The effectiveness of intensive antithrombotic therapy in reducing mortality remains uncertain.
- Understanding optimal anticoagulation and antiplatelet strategies is crucial for managing severe COVID-19.
Purpose of the Study:
- To evaluate the impact of intermediate-dose versus prophylactic-dose anticoagulation on in-hospital mortality in COVID-19 patients.
- To assess the effect of in-hospital aspirin compared to no antiplatelet therapy on in-hospital mortality in COVID-19 patients.
- To analyze mortality outcomes in a large cohort of hospitalized adult COVID-19 patients receiving different antithrombotic regimens.
Main Methods:
- Retrospective study of 2785 hospitalized adult COVID-19 patients.
- Two nested cohorts were analyzed: anticoagulation (intermediate vs. prophylactic dose) and aspirin (in-hospital vs. none).
- Propensity score matching and multivariable regression were used to minimize bias and adjust for confounding factors.
Main Results:
- In the anticoagulation cohort (N=382), intermediate-dose anticoagulation was associated with significantly lower in-hospital death (HR 0.518).
- In the aspirin cohort (N=638), in-hospital aspirin was associated with significantly lower in-hospital death (HR 0.522).
- Both intermediate-dose anticoagulation and aspirin demonstrated a significant reduction in cumulative in-hospital mortality.
Conclusions:
- Intermediate-dose anticoagulation therapy is associated with reduced in-hospital mortality in hospitalized COVID-19 patients.
- In-hospital aspirin use is associated with reduced in-hospital mortality in hospitalized COVID-19 patients not on home antiplatelet therapy.
- These findings suggest that optimized antithrombotic strategies can improve outcomes for critically ill COVID-19 patients.
Abstract:
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.
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