Association between antithrombotic therapy and mortality in patients hospitalized for COVID‑19
Xing Wang1, Wuqian Chen1, Jiulin Guo2
1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Insights
Oral anticoagulants (OACs) significantly reduced mortality in hospitalized COVID-19 patients. Antithrombotic therapy also lowered mortality risk in critically ill patients requiring mechanical ventilation.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
Background:
- COVID-19 is associated with a prothrombotic state, increasing thrombotic risks.
- The role of anticoagulants, particularly oral anticoagulants (OACs), in managing COVID-19 remains controversial due to limited evidence.
- This study addresses the need for clarity on antithrombotic therapy's impact on COVID-19 patient outcomes.
Purpose of the Study:
- To evaluate the association between antithrombotic therapy and mortality in hospitalized COVID-19 patients.
- To assess the impact of antithrombotic therapy on clinical outcomes, including ICU admission and mechanical ventilation.
- To investigate the specific effects of oral anticoagulants (OACs) in this patient population.
Main Methods:
- Retrospective cohort study including adult COVID-19 patients.
- Propensity score matching (PSM) used to control for baseline characteristics.
- In-hospital mortality, ICU admission, mechanical ventilation, and acute kidney injury (AKI) were primary and secondary outcomes.
Main Results:
- Patients receiving OACs showed significantly lower in-hospital mortality compared to those without antithrombotic therapy (aOR: 0.46, P=0.017).
- PSM analysis confirmed the reduced mortality risk with OACs (aOR: 0.35, P<0.001).
- Antithrombotic treatment was associated with reduced mortality in critically ill COVID-19 patients requiring mechanical ventilation (aOR: 0.54, P=0.022).
Conclusions:
- Oral anticoagulants (OACs) are associated with reduced hospital mortality and mechanical ventilation needs in COVID-19 patients.
- Antithrombotic therapy demonstrates a significant reduction in in-hospital mortality among critically ill COVID-19 patients requiring mechanical ventilation.
Background:
The prothrombotic state is a common abnormality in patients with coronavirus disease 2019 (COVID-19). However, there is controversy over the use of anticoagulants, especially oral anticoagulants (OAC) due to limited studies. We sought to evaluate the association between antithrombotic therapy on mortality and clinical outcomes in patients hospitalized for COVID-19 through propensity score matching (PSM) analysis.
Methods:
A retrospective cohort study was performed to include adult patients with COVID-19 in a university hospital. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and acute kidney injury (AKI) during hospitalization. PSM was used as a powerful tool for matching patients' baseline characteristics. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated from the models.
Results:
Of 4,881 COVID-19 patients during the study period, 690 (14.1%) patients received antithrombotic therapy and 4,191 (85.9%) patients were under no antithrombotic therapy. After adjustment with multivariate regression analysis, patients receiving OAC, compared with those who did not receive any antithrombotic therapy, had significantly lower odds for in-hospital mortality (aOR: 0.46. 95% CI: 0.24 to 0.87; P= 0.017). PSM analysis observed similar results (aOR: 0.35. 95% CI: 0.19 to 0.61; P< 0.001). Moreover, in critically ill patients who received mechanical ventilation, antithrombotic treatment (aOR: 0.54. 95% CI: 0.32 to 0.89; P= 0.022) was associated with reduced risk of mortality.
Conclusions:
The application OACs was associated with reduced hospital mortality and mechanical ventilation requirement in COVID-19 patients. Besides, antithrombotic treatment was associated with a reduction in in-hospital mortality among critically ill COVID-19 patients who required mechanical ventilation.
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