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Trends in Venous Thromboembolism Anticoagulation in Patients Hospitalized With COVID-19.
Vaughn, Valerie M; Yost, Monica; Abshire, Chelsea; Flanders, Scott A; Paje, David; Grant, Paul; Kaatz, Scott; Kim, Tae; Barnes, Geoffrey D.
  • Vaughn VM; Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City.
  • Yost M; Division of Health System Innovation & Research, Department of Population Health Science, University of Utah, Salt Lake City.
  • Abshire C; Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.
  • Flanders SA; Michigan Value Collaborative, Department of Surgery, University of Michigan, Ann Arbor.
  • Paje D; Michigan Value Collaborative, Department of Surgery, University of Michigan, Ann Arbor.
  • Grant P; Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.
  • Kaatz S; Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.
  • Kim T; Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.
  • Barnes GD; Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan.
JAMA Netw Open ; 4(6): e2111788, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1265353
Semantic information from SemMedBD (by NLM)
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2. COVID-19 AFFECTS Negative Regulation of Coagulation
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ABSTRACT
Importance Venous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality.

Objective:

To characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality. Design, Setting, and

Participants:

This cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients hospitalized between March 7, 2020, and June 17, 2020. Data were analyzed through March 2021. Exposures Nonadherence to VTE prophylaxis (defined as missing ≥2 days of VTE prophylaxis) and receipt of treatment-dose or prophylactic-dose anticoagulants vs no anticoagulation during hospitalization. Main Outcomes and

Measures:

The effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality was assessed using multinomial logit models with inverse probability of treatment weighting.

Results:

Of a total 1351 patients with COVID-19 included (median [IQR] age, 64 [52-75] years; 47.7% women, 48.9% Black patients), only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.61 per week). Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose aHR, 0.71; 95% CI, 0.51-0.90; treatment dose aHR, 0.92; 95% CI, 0.63-1.35). Conclusions and Relevance This large, multicenter cohort of patients hospitalized with COVID-19, found evidence of rapid dissemination and implementation of anticoagulation strategies, including use of treatment-dose anticoagulation. As only prophylactic-dose anticoagulation was associated with lower 60-day mortality, prophylactic dosing strategies may be optimal for patients hospitalized with COVID-19.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Venous Thromboembolism / SARS-CoV-2 / COVID-19 / Hospitalization / Anticoagulants Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Venous Thromboembolism / SARS-CoV-2 / COVID-19 / Hospitalization / Anticoagulants Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article