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CC BY 4.0 · TH Open 2020; 04(03): e263-e270
DOI: 10.1055/s-0040-1716721
Original Article

Therapeutic Anticoagulation Delays Death in COVID-19 Patients: Cross-Sectional Analysis of a Prospective Cohort

Filip Ionescu 
1   Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
,
Giovi Grasso-Knight
2   Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
,
Edward Castillo
3   Department of Radiation Oncology, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
4   Department of Computational and Applied Mathematics, Rice University, Texas, United States
,
Ehsun Naeem
1   Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
,
Ioana Petrescu
1   Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
,
Zaid Imam
1   Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
,
Vishal K. Patel
2   Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
,
Mangala Narasimhan
5   Division of Pulmonary and Critical Care Medicine, North Well, New York, New York, United States
,
Girish B. Nair
2   Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States
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Abstract

A hypercoagulable state has been described in coronavirus disease 2019 (COVID-19) patients. Others have reported a survival advantage with prophylactic anticoagulation (pAC) and therapeutic anticoagulation (tAC), but these retrospective analyses have important limitations such as confounding by indication. We studied the impact of tAC and pAC compared with no anticoagulation (AC) on time to death in COVID-19. We performed a cross-sectional analysis of 127 deceased COVID-19 patients and compared time to death in those who received tAC (n = 67), pAC (n = 47), and no AC (n = 13). Median time to death was longer with higher doses of AC (11 days for tAC, 8 days for pAC, and 4 days for no AC, p < 0.001). In multivariate analysis, AC was associated with longer time to death, both at prophylactic (hazard ratio [HR] = 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.001) and therapeutic doses (HR = 0.15; 95% CI: 0.07 to 0.32; p < 0.001) compared with no AC. Bleeding rates were similar among tAC and remaining patients (19 vs. 18%; p = 0.877). In deceased COVID-19 patients, AC was associated with a delay in death in a dose-dependent manner. Randomized trials are required to prospectively investigate the benefit and safety of higher doses of AC in this population.

Keywords

anticoagulation - COVID-19 - novel coronavirus - heparin

Authors' Contributions

All authors contributed to data collection, and manuscript revision. F.I. and G.N. analyzed data and drafted the manuscript. E.D. contributed to data analysis. All authors approved the final version.


Supplementary Material



Publication History

Received: 15 June 2020

Accepted: 11 August 2020

Article published online:
26 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

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