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Therapeutic Anticoagulation Delays Death in COVID-19 Patients: Cross-Sectional Analysis of a Prospective Cohort.
Ionescu, Filip; Grasso-Knight, Giovi; Castillo, Edward; Naeem, Ehsun; Petrescu, Ioana; Imam, Zaid; Patel, Vishal K; Narasimhan, Mangala; Nair, Girish B.
  • Ionescu F; Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States.
  • Grasso-Knight G; Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States.
  • Castillo E; Department of Radiation Oncology, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States.
  • Naeem E; Department of Computational and Applied Mathematics, Rice University, Texas, United States.
  • Petrescu I; Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States.
  • Imam Z; Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States.
  • Patel VK; Department of Internal Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States.
  • Narasimhan M; Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, Oakland University William Beaumont School of Medicine, Michigan, United States.
  • Nair GB; Division of Pulmonary and Critical Care Medicine, North Well, New York, New York, United States.
TH Open ; 4(3): e263-e270, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-809172
ABSTRACT
A hypercoagulable state has been described in coronavirus disease 2019 (COVID-19) patients. Others have reported a survival advantage with prophylactic anticoagulation (pAC) and therapeutic anticoagulation (tAC), but these retrospective analyses have important limitations such as confounding by indication. We studied the impact of tAC and pAC compared with no anticoagulation (AC) on time to death in COVID-19. We performed a cross-sectional analysis of 127 deceased COVID-19 patients and compared time to death in those who received tAC ( n = 67), pAC ( n = 47), and no AC ( n = 13). Median time to death was longer with higher doses of AC (11 days for tAC, 8 days for pAC, and 4 days for no AC, p < 0.001). In multivariate analysis, AC was associated with longer time to death, both at prophylactic (hazard ratio [HR] = 0.29; 95% confidence interval [CI] 0.15 to 0.58; p < 0.001) and therapeutic doses (HR = 0.15; 95% CI 0.07 to 0.32; p < 0.001) compared with no AC. Bleeding rates were similar among tAC and remaining patients (19 vs. 18%; p = 0.877). In deceased COVID-19 patients, AC was associated with a delay in death in a dose-dependent manner. Randomized trials are required to prospectively investigate the benefit and safety of higher doses of AC in this population.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: TH Open Year: 2020 Document Type: Article Affiliation country: S-0040-1716721

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: TH Open Year: 2020 Document Type: Article Affiliation country: S-0040-1716721