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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
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Anticoagulation Management and Outcomes in Patients With Covid-19 With Propensity Score Matching: A Multicenter

Jasmeet Kaur1, Jennifer deLongpre2, Tracy Koehler2

  • 1Department of Internal Medicine, Saint Joseph Mercy Oakland Hospital, Pontiac, MI.

American Journal of Therapeutics
|January 7, 2022
PubMed

Insights

For hospitalized COVID-19 patients without blood clots, therapeutic anticoagulation showed no mortality benefit over prophylactic doses. This study found similar outcomes for both treatment groups, questioning the routine use of full-dose anticoagulation.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Hematology

Background:

  • The use of therapeutic anticoagulation in COVID-19 patients without established thromboembolism lacks robust evidence.
  • Current practice often involves administering full-dose anticoagulation despite limited supporting data.

Purpose of the Study:

  • To compare in-hospital mortality and other outcomes between COVID-19 patients receiving therapeutic anticoagulation versus prophylactic anticoagulation.
  • To evaluate the efficacy of full-dose anticoagulation in hospitalized COVID-19 patients without thromboembolic events.

Main Methods:

  • Multicenter retrospective cohort study involving 7 community hospitals.
  • Inclusion criteria: COVID-19 positive patients, >18 years old, hospitalized between March and May 2020.
  • Propensity score matching used to compare patients receiving therapeutic anticoagulation (excluding VTE, AF, MI) versus prophylactic anticoagulation.

Main Results:

  • Analysis included 115 patients in the therapeutic anticoagulation group and 115 in the prophylactic group.
  • 30-day in-hospital mortality rates were similar: 33.0% for therapeutic vs. 28.7% for prophylactic.
  • No significant association found between treatment type and 30-day mortality after controlling for institution; length of stay and readmissions were also similar.

Conclusions:

  • Therapeutic doses of anticoagulation did not demonstrate a significant mortality benefit compared to prophylactic doses in hospitalized COVID-19 patients without clinically evident venous thromboembolism, atrial fibrillation, or myocardial infarction.
  • Findings suggest that the routine use of full-dose anticoagulation in this patient population may not be warranted.
  • Further research may be needed to refine anticoagulation strategies for COVID-19 patients.
Abstract

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