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Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry.
Kirkup, Christian; Pawlowski, Colin; Puranik, Arjun; Conrad, Ian; O'Horo, John C; Gomaa, Dina; Banner-Goodspeed, Valerie M; Mosier, Jarrod M; Zabolotskikh, Igor Borisovich; Daugherty, Steven K; Bernstein, Michael A; Zaren, Howard A; Bansal, Vikas; Pickering, Brian; Badley, Andrew D; Kashyap, Rahul; Venkatakrishnan, A J; Soundararajan, Venky.
  • Kirkup C; nference, Inc., Cambridge, Massachusetts, USA.
  • Pawlowski C; nference, Inc., Cambridge, Massachusetts, USA.
  • Puranik A; nference, Inc., Cambridge, Massachusetts, USA.
  • Conrad I; nference, Inc., Cambridge, Massachusetts, USA.
  • O'Horo JC; Mayo Clinic, Rochester, Minnesota, USA.
  • Gomaa D; University of Cincinnati, Cincinnati, Ohio, USA.
  • Banner-Goodspeed VM; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Mosier JM; Banner University Medical Center, Tucson, Arizona, USA.
  • Zabolotskikh IB; Kuban State Medical University, Krasnodar, Russia.
  • Daugherty SK; Cox Medical Center, Springfield, Missouri, USA.
  • Bernstein MA; Stamford Health, Stamford, Connecticut, USA.
  • Zaren HA; St. Joseph's Candler Health System, Savannah, Georgia, USA.
  • Bansal V; Mayo Clinic, Rochester, Minnesota, USA.
  • Pickering B; Mayo Clinic, Rochester, Minnesota, USA.
  • Badley AD; Mayo Clinic, Rochester, Minnesota, USA.
  • Kashyap R; Mayo Clinic, Rochester, Minnesota, USA.
  • Venkatakrishnan AJ; nference, Inc., Cambridge, Massachusetts, USA.
  • Soundararajan V; nference, Inc., Cambridge, Massachusetts, USA.
J Med Virol ; 93(7): 4303-4318, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1118166
Preprint
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Semantic information from SemMedBD (by NLM)
1. Anticoagulation Therapy TREATS COVID-19
Subject
Anticoagulation Therapy
Predicate
TREATS
Object
COVID-19
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Anticoagulation Therapy TREATS Patients
Subject
Anticoagulation Therapy
Predicate
TREATS
Object
Patients
4. enoxaparin ADMINISTERED_TO Patients
Subject
enoxaparin
Predicate
ADMINISTERED_TO
Object
Patients
5. heparin NEG_ADMINISTERED_TO Patients
Subject
heparin
Predicate
NEG_ADMINISTERED_TO
Object
Patients
6. heparin ADMINISTERED_TO Patients
Subject
heparin
Predicate
ADMINISTERED_TO
Object
Patients
7. enoxaparin NEG_ADMINISTERED_TO Patients
Subject
enoxaparin
Predicate
NEG_ADMINISTERED_TO
Object
Patients
8. Anticoagulation Therapy TREATS COVID-19
Subject
Anticoagulation Therapy
Predicate
TREATS
Object
COVID-19
9. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
10. Anticoagulation Therapy TREATS Patients
Subject
Anticoagulation Therapy
Predicate
TREATS
Object
Patients
11. enoxaparin ADMINISTERED_TO Patients
Subject
enoxaparin
Predicate
ADMINISTERED_TO
Object
Patients
12. heparin NEG_ADMINISTERED_TO Patients
Subject
heparin
Predicate
NEG_ADMINISTERED_TO
Object
Patients
13. heparin ADMINISTERED_TO Patients
Subject
heparin
Predicate
ADMINISTERED_TO
Object
Patients
14. enoxaparin NEG_ADMINISTERED_TO Patients
Subject
enoxaparin
Predicate
NEG_ADMINISTERED_TO
Object
Patients
ABSTRACT
Here we analyze hospitalized andintensive care unit coronavirus disease 2019 (COVID-19) patient outcomes from the international VIRUS registry (https//clinicaltrials.gov/ct2/show/NCT04323787). We find that COVID-19 patients administered unfractionated heparin but not enoxaparin have a higher mortality-rate (390 of 1012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1939 = 14%), presenting a risk ratio of 2.79 (95% confidence interval [CI] [2.42, 3.16]; p = 4.45e-52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin versus 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% CI [1.42, 2.00]; p = 1.5e-8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2644 [25%]), risk ratio 1.26 (95% CI [1.14, 1.40]; p = 7.5e-5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1047 [30%] for Black/African American vs. 263 of 1047 [25%] for White/Caucasian, p = .02, risk ratio 1.18; 95% CI [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow-up prospective research into the observed racial disparity in anticoagulant use and outcomes for severe COVID-19 patients.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Heparin / Enoxaparin / Healthcare Disparities / COVID-19 / Anticoagulants Type of study: Cohort study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: J Med Virol Year: 2021 Document Type: Article Affiliation country: Jmv.26918

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Heparin / Enoxaparin / Healthcare Disparities / COVID-19 / Anticoagulants Type of study: Cohort study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: J Med Virol Year: 2021 Document Type: Article Affiliation country: Jmv.26918