Related Experiment Video
Updated: Jul 11, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Anticoagulation Use as an Independent Predictor of Mortality and Major Adverse Cardiovascular Events in Hospitalized
Nathan DeRon1, Lawrence Hoang1, Kristopher Aten1
1Department of Internal Medicine, Methodist Dallas Medical Center, Dallas, TX, USA.
Insights
Ambulatory anticoagulation (AC) in hospitalized COVID-19 patients was linked to more major adverse cardiovascular events (MACEs) but lower mortality. This finding aids in risk stratification and management for these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Coronavirus disease 2019 (COVID-19) is known to increase risks of cardiac arrhythmias and thrombotic events.
- The impact of ambulatory anticoagulation (AC) therapy on cardiovascular outcomes in COVID-19 patients remains unclear.
- This study investigated the effects of AC use in hospitalized COVID-19 patients.
Purpose of the Study:
- To determine the cardiovascular outcomes associated with ambulatory anticoagulation (AC) therapy in hospitalized COVID-19 patients.
- To analyze the incidence of major adverse cardiovascular events (MACEs) and all-cause mortality in AC users versus non-users.
Main Methods:
- A multicenter, retrospective study of 2,801 hospitalized COVID-19 patients (March 2020 - July 2021).
- Patients were categorized into ambulatory AC users (375) and non-users.
- Data on mortality and MACEs (including heart failure, myocardial infarction, pulmonary embolism, stroke) were collected from electronic health records.
- Multivariate logistic regression was used to adjust for comorbidities.
Main Results:
- Ambulatory AC users had a significantly lower incidence of all-cause mortality compared to non-users (7.7% vs. 13.9%, P = 0.001).
- However, AC users experienced a higher incidence of MACEs (44.8% vs. 26.8%, P < 0.001).
- Key drivers for increased MACEs in AC users included higher rates of acute heart failure, myocardial infarction, pulmonary embolism/deep venous thrombosis, and stroke.
Conclusions:
- Ambulatory anticoagulation use in hospitalized COVID-19 patients is associated with an increased risk of MACEs.
- Conversely, AC use demonstrated a significant reduction in all-cause mortality.
- Findings can assist clinicians in identifying high-risk patients and tailoring management strategies.
Background:
Coronavirus disease 2019 (COVID-19) is associated with increased incidence of cardiac arrhythmias and thrombotic events. The adverse cardiovascular outcomes related to ambulatory anticoagulation (AC) therapy in COVID-19 patients are unknown. The goal of this study was to identify the effects of AC use in hospitalized COVID-19 patients.
Methods:
This is a multicenter, retrospective study that identified 2,801 hospitalized COVID-19 polymerase chain reaction (PCR)-positive patients admitted between March 2020 and July 2021. Of these, 375 (13.4%) were ambulatory AC users. Data were collected from the electronic health records of hospitalized patients. Mortality included in-hospital death and hospice referral. Major adverse cardiovascular events (MACEs) included acute heart failure (HF), myocardial infarction (MI), myocarditis, pulmonary embolism (PE), deep venous thrombosis (DVT), pericardial effusion, pericarditis, stroke, shock, and cardiac tamponade. A Chi-square test was used to analyze categorical variables, and multivariate logistic regression analysis was performed to account for comorbidities.
Results:
AC non-users exhibited a higher incidence of mortality than AC users (13.9% vs. 7.7%, P = 0.001). However, MACE incidence was higher in AC users than AC non-users (44.8% vs. 26.8%, P < 0.001). The higher MACE incidence was driven by higher rates of acute HF (8.3% vs. 2.5%, P < 0.001), MI (26.9% vs. 18.2%, P < 0.001), PE/DVT (16.3% vs. 2.7%, P < 0.001), pericardial effusion (1.6% vs. 0.5%, P = 0.025), and stroke (2.9% vs. 1.2%, P = 0.018). After multivariate logistic regression, MACE incidence remained higher (odds ratio (OR) = 1.61, 95% confidence interval (CI): 1.27 - 2.05, P < 0.001) and all-cause mortality rate lower (OR = 0.34, 95% CI: 0.23 - 0.52, P < 0.001) in AC users.
Conclusions:
Ambulatory AC use is associated with increased MACEs but decreased all-cause mortality in patients hospitalized with COVID-19. This study will help physicians identify patients at risk of cardiovascular mortality and direct management based on the identified risk.
More Related Videos
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Venous Thrombosis IV: Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management