Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19

Paranjpe I, Fuster V, Lala A, et al. J Am Coll Cardiol. 2020 May 5. pii: S0735-1097(20)35218-9. [Epub ahead of print] [CrossRef] [PubMed] 

The novel coronavirus 2019 (COVID-19) has been associated with reports of increased thromboembolic events and anecdotal observations of improved outcomes with systemic anticoagulation (AC). The authors assessed the association between administration of in-hospital AC and survival in a large cohort of hospitalized patients with COVID-19. Between March 14 and April 11, 2020, 2,773 patients were hospitalized with laboratory\confirmed COVID-19 within the Mount Sinai Health System in New York City. The authors used a Cox proportional hazards model to evaluate the effect of treatment-dose systemic AC (including oral, subcutaneous, or intravenous forms) on in-hospital mortality. 786 (28%) received systemic AC during their hospital course. In-hospital mortality for patients treated with AC was 22.5% with a median survival of 21 days, compared to 22.8% and median survival of 14 days in patients who did not receive AC. In patients who required mechanical ventilation (N=395), in-hospital mortality was 29.1% with a median survival of 21 days for those treated with AC as compared to 62.7% with a median survival of 9 days in patients who did not receive AC. In a multivariate proportional hazards model, longer duration of AC treatment was associated with a reduced risk of mortality (adjusted HR of 0.86 per day, 95% confidence interval 0.82-0.89, p<0.001). Although limited by its observational nature, unobserved confounding, unknown indication for AC, lack of metrics to further classify illness severity in the mechanically ventilated subgroup, and indication bias, the findings suggest that systemic AC may be associated with improved outcomes among patients hospitalized with COVID-19. It should be noted that similar arguments were made for systemic anticoagulation in ARDS but when subjected to randomized trials, anticoagulation made no mortality difference.