ABSTRACT
Background : Patients with COVID-19 have a hypercoagulable state with increased risk of thrombotic venous events (VTE). These thrombotic complications could be responsible for a significant part of the morbidity and mortality seen in COVID-19 patients. The high incidence of VTE is seen even despite the use of apparently adequate thrombosis prophylaxis. Therefore, it is suggested that in COVID-19 patients increased intensity thromboprophylaxis or therapeutic anticoagulation should be considered. Aims : We investigated whether the use of therapeutic anticoagulation prior to infection has a beneficial effect on morbidity and mortality in hospitalized COVID-19 patients. Methods : In this multicenter retrospective cohort study, all ≥18 years old COVID-19 patients admitted to 6 hospitals in the Netherlands between March and May 2020 were included. We applied 1:3 propensity score matching to evaluate the association between prior therapeutic anticoagulation use and clinical outcome, with in hospital mortality as primary endpoint. Relevant secondary outcomes included admission to the intensive care unit (ICU), need for invasive mechanical ventilation, pulmonary embolism and length of hospital stay Results : A total of 1154 patients were included, of whom 190 (16%) patients used therapeutic anticoagulation prior to admission. In the propensity score matched analyses, we observed no association between prior use of therapeutic anticoagulation and in hospital mortality compared to no prior use of anticoagulation (RR 1.02 (95% CI;0.80-1.30). We also found no significant differences in secondary outcomes apart from a lower risk of pulmonary embolism in patients using therapeutic anticoagulation prior to infection (RR 0.19 (95% CI;0.05-0.80). Conclusions : Although prior therapeutic anticoagulation use is associated with reduced PE occurrence, it is not associated with better outcome parameters in hospitalized COVID-19 patients in terms of all-cause mortality, ICU admittance, need for mechanical ventilation, and length of hospital stay.
ABSTRACT
BACKGROUND: Previous studies have reported on myocardial injury in patients with coronavirus infectious disease 19 (COVID-19) defined as elevated cardiac biomarkers. Whether elevated biomarkers truly represent myocardial dysfunction is not known. The aim of this study was to explore the incidence of ventricular dysfunction and assess its relationship with biomarker analyses. METHODS: This cross-sectional study ran from April 1 to May 12, 2020, and consisted of all consecutively admitted patients to the Radboud university medical centre nursing ward for COVID-19. Laboratory assessment included high-sensitivity Troponin T and Nterminal pro-B-type natriuretic peptide (NT-proBNP). Echocardiographic evaluation focused on left and right ventricular systolic function and global longitudinal strain (GLS). RESULTS: In total, 51 patients were included, with a median age of 63 years (range 51-68 years) of whom 80% was male. Troponin T was elevated (>14â¯ng/l) in 47%, and a clinically relevant Troponin T elevation (10â¯× URL) was found in three patients (6%). NT-proBNP was elevated (>300â¯pg/ml) in 24 patients (47%), and in four (8%) the NT-proBNP concentration was >1,000â¯pg/ml. Left ventricular dysfunction (ejection fraction <52% and/or GLS >-18%) was observed in 27%, while right ventricular dysfunction (TAPSE <17â¯mm and/or RV S'â¯< 10â¯cm/s) was seen in 10%. There was no association between elevated Troponin T or NT-proBNP and left or right ventricular dysfunction. Patients with confirmed pulmonary embolism had normal right ventricular function. CONCLUSIONS: In hospitalised patients, it seems that COVID-19 predominantly affects the respiratory system, while cardiac dysfunction occurs less often. Based on a single echocardiographic evaluation, we found no relation between elevated Troponin T or NT-proBNP, and ventricular dysfunction. Echocardiography has limited value in screening for ventricular dysfunction.