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The intensity of anticoagulant dosing in hospitalized patients with COVID-19: An observational, comparative
Laura C Myers1, Stanley Xu2, Aiyu Chen2
1Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA.
Insights
For hospitalized COVID-19 patients, intermediate or full-dose anticoagulation showed no difference in in-hospital death compared to standard prophylaxis. This real-world study provides insights into optimal anticoagulant strategies for coronavirus disease-2019 care.
Area of Science:
- Internal Medicine
- Critical Care Medicine
- Pharmacology
Background:
- The optimal anticoagulant dosing strategy for hospitalized patients with coronavirus disease-2019 (COVID-19) remains unclear.
- Existing randomized trials have yielded mixed results regarding the effectiveness of different anticoagulation intensities on in-hospital mortality.
Purpose of the Study:
- To investigate the association between varying intensities of anticoagulation and clinical outcomes, specifically in-hospital death.
- To compare the effectiveness of standard prophylactic, intermediate-dose, and full-dose anticoagulation in hospitalized COVID-19 patients.
Main Methods:
- A retrospective cohort study was conducted involving 17,130 hospitalized patients with COVID-19 and respiratory impairment.
- Propensity score models were utilized to compare outcomes between patients receiving standard prophylactic, intermediate, or full-dose anticoagulation.
- Exposure was defined by the highest anticoagulation dose administered on admission or within 24 hours of respiratory deterioration.
Main Results:
- No significant differences in the odds of in-hospital death were observed between patients receiving intermediate-dose or full anticoagulation compared to standard prophylaxis on admission.
- Similarly, for patients experiencing respiratory deterioration, neither intermediate nor full-dose anticoagulation showed a significant difference in in-hospital death rates compared to standard prophylaxis.
- Propensity score-adjusted analyses indicated no improved survival with higher anticoagulation doses in this patient cohort.
Conclusions:
- Real-world evidence suggests that intermediate-dose or full anticoagulation does not reduce in-hospital mortality in newly admitted or deteriorating COVID-19 patients compared to standard prophylaxis.
- These findings contribute to understanding the comparative effectiveness of different anticoagulation strategies in COVID-19 management.
Background:
The question of anticoagulant dosing in hospitalized patients with coronavirus disease-2019 (COVID-19) is unresolved, with randomized trials showing mixed results and heterogeneity of treatment effects for in-hospital death.
Objective:
To examine the association between the intensity of anticoagulation and clinical outcomes in hospitalized patients with COVID-19.
Design, Setting And Participants:
Retrospective cohort study of patients with COVID-19 and respiratory impairment who were hospitalized between 3/1/2020-12/31/2020 in two Kaiser Permanente regions.
Exposure And Main Outcome:
We fit propensity score models using categorical regression to estimate the probability of receiving standard prophylactic, intermediate, or full-dose anticoagulation beginning on the day of admission or on the day of first respiratory deterioration. Exposure was defined by the highest dose on the day of admission or within 24 hours after deterioration. The primary outcome was in-hospital death.
Results:
We included 17,130 patients in the day of admission analysis and 4,924 patients who experienced respiratory deterioration. There were no differences in propensity score-adjusted odds of in-hospital death for patients who received either intermediate (odds ratio [OR]: 1.00, 95% confidence intervals [CI] 0.89-1.12) or full anticoagulation (OR: 1.00, 95% CI: 0.85-1.17) compared with standard prophylaxis beginning on the day of admission. Similarly, there were no differences in in-hospital death for either intermediate (OR: 1.22, 95% CI: 0.82-1.82) or full anticoagulation (OR: 1.50, 95% CI: 0.90-2.51) compared with standard prophylaxis on the day of deterioration.
Conclusion:
Results of this real-world, comparative effectiveness study showed no differences in in-hospital death among newly admitted or deteriorating patients with COVID-19 who received intermediate-dose or full anticoagulation compared with standard prophylaxis.
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