Anticoagulation in Hospitalized COVID-19 Patients May Improve Outcomes


Anticoagulation was associated with increased survival time and bleeding events were similar between treated and non-treated patients.

Patients hospitalized with COVID-19 who received anticoagulants had improved outcomes compared with those who did not, according to a research letter published May 6 in the Journal of the American College of Cardiology.

Investigators at the Ichan School of Medicine at Mount Sinai in New York, led by Ishan Paranjpe, MD, evaluated records of 2733 patients with confirmed COVID-19 admitted to 5 hospitals in the Mt Sinai Health System between March 14 and April 11, 2020.

Adjustments for Confounding

  • Age/sex
  • Ethnicity
  • History of HTN, HF, Afib, T2D
  • Anticoagulation use prior to hospitalization
  • Admission date

Duration of anticoagulation treatment was used as a covariate and intubation was treated as a time-dependent variable.

Of these patients 786 (28%) received systemic anticoagulation during their hospital stay. The median length of stay was 5 days; median time from admission to anticoagulation initiation, 2 days; and median length of anticoagulation treatment, 3 days.

  • In-hospital mortality among patients who received anticoagulation was 22.5% vs 22.8% of those who did not; median survival was 14 days vs 21 days, respectively.
  • Mechanical ventilation (MV) was more common among patients who received anticoagulation (29.8% vs. 8.1%).
  • In hospital mortality for patients who did require MV (median survival):
    • Anticoagulation: 29.1% (21 days)
    • No anticoagulation 62.7% (9 days)

Using a multivariate proportional hazards model, longer duration of anticoagulation treatment was associated with a reduced mortality risk (adjusted HR, 0.86/day; 95% CI 0.82 to 0.89; p<.001).

Authors report observing significantly increased baseline prothrombin time, activated partial thromboplastin time, lactate dehydrogenase, ferritin, C-reactive protein, and D-dimer values among individuals who received in-hospital AC vs those who did not. Of interest, these differences were not observed in patients who required MV.

Among patients on anticoagulation, 24 (3%) had bleeding events vs 38 (1.9%) among those who did not receive anticoagulation (p=0.2). Bleeding events were more common among intubated (7.5%) vs. nonincubated (1.35%) patients.

The study’s senior corresponding author Valentin Fuster, MD, PhD, director, Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital said in a press release from Mount Sinai Hospital / Mount Sinai School of Medicine:

"This research demonstrates anticoagulants taken orally, subcutaneously, or intravenously may play a major role in caring for COVID-19 patients, and these may prevent possible deadly events associated with coronavirus, including heart attack, stroke, and pulmonary embolism.

Using anticoagulants should be considered when patients get admitted to the ER and have tested positive for COVID-19 to possibly improve outcomes. However, each case should be evaluated an individualized basis to account for potential bleeding risk."

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