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Enoxaparin is associated with lower rates of mortality than unfractionated Heparin in hospitalized COVID-19 patients.
Pawlowski, Colin; Venkatakrishnan, A J; Kirkup, Christian; Berner, Gabriela; Puranik, Arjun; O'Horo, John C; Badley, Andrew D; Soundararajan, Venky.
  • Pawlowski C; nference inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA.
  • Venkatakrishnan AJ; nference inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA.
  • Kirkup C; nference inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA.
  • Berner G; nference inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA.
  • Puranik A; nference inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA.
  • O'Horo JC; Mayo Clinic, Rochester, MN, USA.
  • Badley AD; Mayo Clinic, Rochester, MN, USA.
  • Soundararajan V; nference inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA.
EClinicalMedicine ; 33: 100774, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1120898
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ABSTRACT

BACKGROUND:

Coagulopathies are a major class among COVID-19 associated complications. Although anticoagulants such as unfractionated Heparin and Enoxaparin are both being used for therapeutic mitigation of COVID associated coagulopathy (CAC), differences in their clinical outcomes remain to be investigated.

METHODS:

We analyzed records of 1,113 patients in the Mayo Clinic Electronic Health Record (EHR) database who were admitted to the hospital for COVID-19 between April 4, 2020 and August 31, 2020, including 19 different Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Among this patient population, we compared cohorts of patients who received different types of anticoagulants, including 441 patients who received unfractionated Heparin and 166 patients who received Enoxaparin. Clinical outcomes at 28 days were compared, and propensity score matching was used to control for potential confounding variables including demographics, comorbidities, ICU status, chronic kidney disease stage, and oxygenation status. Patients with a history of acute kidney injury and patients who received multiple types of anticoagulants were excluded from the study.

FINDINGS:

We find that COVID-19 patients administered unfractionated Heparin but not Enoxaparin have higher rates of 28-day mortality (risk ratio 4.3; 95% Confidence Interval [C.I.]. [1.8, 10.2]; p-value 8.5e-4, Benjamini Hochberg [BH] adjusted p-value 2.1e-3), after controlling for potential confounding factors.

INTERPRETATION:

This study emphasizes the need for mechanistically investigating differential modulation of the COVID-associated coagulation cascades by Enoxaparin versus unfractionated Heparin.

FUNDING:

This work was supported by Nference, inc.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.100774

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.100774