Your browser doesn't support javascript.
Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study.
Rentsch, Christopher T; Beckman, Joshua A; Tomlinson, Laurie; Gellad, Walid F; Alcorn, Charles; Kidwai-Khan, Farah; Skanderson, Melissa; Brittain, Evan; King, Joseph T; Ho, Yuk-Lam; Eden, Svetlana; Kundu, Suman; Lann, Michael F; Greevy, Robert A; Ho, P Michael; Heidenreich, Paul A; Jacobson, Daniel A; Douglas, Ian J; Tate, Janet P; Evans, Stephen J W; Atkins, David; Justice, Amy C; Freiberg, Matthew S.
  • Rentsch CT; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK christopher.rentsch@lshtm.ac.uk.
  • Beckman JA; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA.
  • Tomlinson L; Cardiovascular Division, Vanderbilt University Medical Center and Vanderbilt Translational and Clinical Cardiovascular Research Center, Nashville, TN, USA.
  • Gellad WF; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
  • Alcorn C; Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA.
  • Kidwai-Khan F; Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
  • Skanderson M; Veterans Affairs Pittsburgh Healthcare System, US Department of Veterans Affairs, Pittsburgh, PA, USA.
  • Brittain E; Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
  • King JT; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA.
  • Ho YL; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
  • Eden S; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA.
  • Kundu S; Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Translational and Clinical Cardiovascular Research Center, Nashville, TN, USA.
  • Lann MF; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA.
  • Greevy RA; Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
  • Ho PM; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.
  • Heidenreich PA; Faculty of Biostatistics, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
  • Jacobson DA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Douglas IJ; Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
  • Tate JP; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Evans SJW; Rocky Mountain Regional VA Medical Center, US Department of Veterans Affairs, Aurora, CO, USA.
  • Atkins D; VA Palo Alto Healthcare System, US Department of Veterans Affairs, Palo Alto, CA, USA.
  • Justice AC; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
  • Freiberg MS; Oak Ridge National Laboratory, Biosciences Division, Oak Ridge, TN, USA.
BMJ ; 372: n311, 2021 02 11.
Article in English | MEDLINE | ID: covidwho-1083594
Semantic information from SemMedBD (by NLM)
1. Negative Regulation of Coagulation PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
PROCESS_OF
Object
Patients
2. Cessation of life PROCESS_OF Patients
Subject
Cessation of life
Predicate
PROCESS_OF
Object
Patients
3. enoxaparin ADMINISTERED_TO Patients
Subject
enoxaparin
Predicate
ADMINISTERED_TO
Object
Patients
4. subcutaneous heparin ADMINISTERED_TO Patients
Subject
subcutaneous heparin
Predicate
ADMINISTERED_TO
Object
Patients
5. Negative Regulation of Coagulation NEG_PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
NEG_PROCESS_OF
Object
Patients
6. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
7. Negative Regulation of Coagulation PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
PROCESS_OF
Object
Patients
8. Cessation of life PROCESS_OF Patients
Subject
Cessation of life
Predicate
PROCESS_OF
Object
Patients
9. enoxaparin ADMINISTERED_TO Patients
Subject
enoxaparin
Predicate
ADMINISTERED_TO
Object
Patients
10. subcutaneous heparin ADMINISTERED_TO Patients
Subject
subcutaneous heparin
Predicate
ADMINISTERED_TO
Object
Patients
11. Negative Regulation of Coagulation NEG_PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
NEG_PROCESS_OF
Object
Patients
12. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

OBJECTIVE:

To evaluate whether early initiation of prophylactic anticoagulation compared with no anticoagulation was associated with decreased risk of death among patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United States.

DESIGN:

Observational cohort study.

SETTING:

Nationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated national healthcare system.

PARTICIPANTS:

All 4297 patients admitted to hospital from 1 March to 31 July 2020 with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and without a history of anticoagulation. MAIN OUTCOME

MEASURES:

The main outcome was 30 day mortality. Secondary outcomes were inpatient mortality, initiating therapeutic anticoagulation (a proxy for clinical deterioration, including thromboembolic events), and bleeding that required transfusion.

RESULTS:

Of 4297 patients admitted to hospital with covid-19, 3627 (84.4%) received prophylactic anticoagulation within 24 hours of admission. More than 99% (n=3600) of treated patients received subcutaneous heparin or enoxaparin. 622 deaths occurred within 30 days of hospital admission, 513 among those who received prophylactic anticoagulation. Most deaths (510/622, 82%) occurred during hospital stay. Using inverse probability of treatment weighted analyses, the cumulative incidence of mortality at 30 days was 14.3% (95% confidence interval 13.1% to 15.5%) among those who received prophylactic anticoagulation and 18.7% (15.1% to 22.9%) among those who did not. Compared with patients who did not receive prophylactic anticoagulation, those who did had a 27% decreased risk for 30 day mortality (hazard ratio 0.73, 95% confidence interval 0.66 to 0.81). Similar associations were found for inpatient mortality and initiation of therapeutic anticoagulation. Receipt of prophylactic anticoagulation was not associated with increased risk of bleeding that required transfusion (hazard ratio 0.87, 0.71 to 1.05). Quantitative bias analysis showed that results were robust to unmeasured confounding (e-value lower 95% confidence interval 1.77 for 30 day mortality). Results persisted in several sensitivity analyses.

CONCLUSIONS:

Early initiation of prophylactic anticoagulation compared with no anticoagulation among patients admitted to hospital with covid-19 was associated with a decreased risk of 30 day mortality and no increased risk of serious bleeding events. These findings provide strong real world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial treatment for patients with covid-19 on hospital admission.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Thromboembolism / Enoxaparin / COVID-19 / Anticoagulants Type of study: Etiology study / Clinical Practice Guide / Observational study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Bmj.n311

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Thromboembolism / Enoxaparin / COVID-19 / Anticoagulants Type of study: Etiology study / Clinical Practice Guide / Observational study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Bmj.n311