Effect of Chronic Oral Therapeutic Anticoagulation on Thrombotic Morbidity and Mortality in Patients Hospitalized with COVID-19

ABSTRACT

Introduction: Infection with SARS-CoV-2 increases the risk of thrombosis and subsequently mortality. The impact of chronic anticoagulation prior to infection, however, is not well defined. Research Question or Hypothesis: Does the use of indicated chronic anticoagulation alter morbidity and mortality from thrombotic complications of COVID-19 in hospitalized patients? Study Design: Single-centered, retrospective chart review from March to December 2020. Method(s) Hospitalized adult patients with a positive COVID-19 test with or without chronic therapeutic anticoagulation were included. Exclusion criteria included pregnancy and hypercoagulable comorbidity not on anticoagulation. The primary endpoint was a combined incidence of venous thromboembolism, arterial thrombosis, myocardial infarction, ischemic stroke, and disseminated intravascular coagulation. Additional endpoints included ventilation or high-flow oxygen requirement, development of acute respiratory distress syndrome (ARDS) or respiratory failure, and bleeding. 152 patients per group would provide 80% power and a two-sided alpha of 0.05 for the primary outcome. Outcomes were analyzed with Chi-square or Fisher's exact tests using SPSS software. Result(s) 733 patients were included (453 not on anticoagulation (No- AC) and 280 on chronic anticoagulation (AC)). There were no differences in baseline characteristics between groups except for the Charlson Comorbidity Index score (No-AC 4.8, AC 5.8;p < 0.001). For the primary endpoint, events occurred in 133 patients (29.4%) in the No- AC group versus 27 patients (9.6%) in the AC group (p < 0.001). For the secondary endpoints, there were differences in need for ventilation [No-AC 101 (22.3%), AC 39 (13.9%);p = 0.005] and development of ARDS [No-AC 252 (55.6%), AC 124 (44.3%);p = 0.003], with no difference in bleed [No-AC 5 (1.1%), AC 7 (2.5%);p = 0.15]. Conclusion(s) Patients hospitalized with COVID-19 infection on chronic anticoagulation had lower incidence of thrombosis and mortality.