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Mortality, critical illness, and mechanical ventilation among hospitalized patients with COVID-19 on therapeutic
Niti G Patel1, Ajay Bhasin1, Joseph M Feinglass2
1Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA.
Thrombosis Update
|April 15, 2024
Summary
Therapeutic anticoagulation did not improve outcomes for hospitalized COVID-19 patients. Starting new anticoagulation for COVID-19 increased risks of death and critical illness compared to prophylactic doses.
Area of Science:
- Internal Medicine
- Critical Care Medicine
- Cardiology
Background:
- COVID-19 is linked to hypercoagulability and increased thrombosis risk.
- Assessing anticoagulation strategies is crucial for managing hospitalized COVID-19 patients.
Purpose of the Study:
- To compare clinical outcomes of COVID-19 inpatients on therapeutic anticoagulation versus prophylactic anticoagulation.
- To evaluate the impact of continued vs. new therapeutic anticoagulation on mortality and critical illness.
Main Methods:
- Observational study of 1716 adult COVID-19 inpatients (March-June 2020).
- Compared outcomes for patients on continued home therapeutic anticoagulation, new therapeutic anticoagulation for COVID-19, and prophylactic anticoagulation.
- Primary outcome: overall death; Secondary outcomes: critical illness, mechanical ventilation, and post-critical illness death. Adjusted for multiple clinical factors.
Main Results:
- Patients continued on home therapeutic anticoagulation showed no outcome differences versus prophylactic doses.
- New therapeutic anticoagulation for COVID-19 was associated with significantly increased risks of death (OR 5.93), critical illness (OR 14.51), mechanical ventilation (OR 11.22), and post-critical illness death (OR 5.51).
Conclusions:
- Therapeutic anticoagulation initiated for COVID-19 did not improve clinical outcomes in hospitalized patients.
- Starting new therapeutic anticoagulation for COVID-19 is associated with worse outcomes.
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