ABSTRACT
SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Initial reports of COVID-19 autopsies revealed significant evidence of micro and macrovascular thrombosis. Due to concern for increased thrombotic events, many institutions implemented anticoagulation (AC) protocols for hospitalized patients. The study’s objective is to evaluate disease progression in patients treated with therapeutic anticoagulation vs. prophylactic anticoagulation in noncritical COVID-19 hospitalized patients. METHODS: We performed a retrospective cohort study of adults hospitalized with COVID-19 pneumonia between March 1-May 1, 2020. Inclusion criteria was any adult patient directly admitted to non-intensive care setting for radiologically confirmed COVID-19 pneumonia. T-test was performed for the continuous variables with normal distribution. Wilcoxon-rank-sum test for non-parametric groups. Chi-squared test for categorical variables. P-value <0.05 was considered statistically significant. RESULTS: Overall, 81 (34%) received therapeutic AC, and 159 (66%) subjected received prophylactic AC. The clinical characteristics of the therapeutic group included: average age 57.8 (vs. 55.7), 77.78% male (vs. 72.92%), 40.74% obese (vs. 37.92%), 64.74% had hypertension (vs. 40.88%), 44.44% had Diabetes Mellitus (vs. 37.92%) and 11.11% had chronic kidney disease (vs. 13.84%). Initial inflammatory markers were higher in therapeutic group vs. prophylactic, including D-dimer (845 vs 361ng/dL), Ferritin (918.5 vs. 632ng/mL), and CRP (20 vs. 11.2mg/dL). The average length of stay (LOS) of the therapeutic group was 10 days (vs. 7 for prophylactic), and a higher number of patients required mechanical ventilation (36 vs. 23), and hemodialysis (18 vs. 6). A higher number of adverse events (bleeding) was noticed in the therapeutic group (13.58% vs. 2.52%) with a p-value of <0.001. Higher odds of In-Hospital mortality observed in therapeutic group subjects with Hypertension (OR=5.41), chronic kidney disease (OR= 4.08), and lung disease (OR= 2.87) with a p-value of <0.05. CONCLUSIONS: In noncritically ill patients with COVID-19, treatment with therapeutic AC was related to greater LOS, requiring mechanical ventilation, hemodialysis, and adverse effects compared to prophylactic AC. We also observed a significantly higher D-dimer, ferritin, and CRP in the therapeutic group. RCT performed by ACTIV-4a investigators demonstrated increased organ support-free days in the therapeutic group, contrary to our study, which showed increased dependence of respiratory support and hemodialysis. Our therapeutic group patients appear to have higher comorbidities and significantly elevated initial inflammatory markers compared to the prophylactic group, which may explain these differences. CLINICAL IMPLICATIONS: Finally, our study supports the use of therapeutic anticoagulation depending on the patient overall clinical scenario. DISCLOSURES: No relevant relationships by Adebola Adetiloye No relevant relationships by Jennifer Arzu No relevant relationships by Kuldeep Ghosh No relevant relationships by Gabriel Ibarra no disclosure on file for Armeen Poor;No relevant relationships by Ingrid Portillo No relevant relationships by Fernando Quesada Mata No relevant relationships by Natoushka Trenard No relevant relationships by Julio Valencia Manrique