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Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19.
Nadkarni, Girish N; Lala, Anuradha; Bagiella, Emilia; Chang, Helena L; Moreno, Pedro R; Pujadas, Elisabet; Arvind, Varun; Bose, Sonali; Charney, Alexander W; Chen, Martin D; Cordon-Cardo, Carlos; Dunn, Andrew S; Farkouh, Michael E; Glicksberg, Benjamin S; Kia, Arash; Kohli-Seth, Roopa; Levin, Matthew A; Timsina, Prem; Zhao, Shan; Fayad, Zahi A; Fuster, Valentin.
  • Nadkarni GN; Mount Sinai Covid Informatics Center, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; The Hasso Plattner Institute of Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; The Charles Bronfman Institute of
  • Lala A; Mount Sinai Covid Informatics Center, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic
  • Bagiella E; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pathology, Molecular and Cell-based Medicine, Icahn Sch
  • Chang HL; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York.
  • Moreno PR; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Pujadas E; Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Arvind V; The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York; Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Bose S; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Charney AW; Mount Sinai Covid Informatics Center, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Chen MD; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Cordon-Cardo C; Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Dunn AS; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Farkouh ME; Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada.
  • Glicksberg BS; Mount Sinai Covid Informatics Center, New York, New York; The Hasso Plattner Institute of Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Kia A; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Kohli-Seth R; Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Levin MA; Mount Sinai Covid Informatics Center, New York, New York; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Timsina P; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Zhao S; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Fayad ZA; Mount Sinai Covid Informatics Center, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Dia
  • Fuster V; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. Electronic address: valentin.fuster@mountsinai.org.
J Am Coll Cardiol ; 76(16): 1815-1826, 2020 10 20.
Article in English | MEDLINE | ID: covidwho-849705
ABSTRACT

BACKGROUND:

Thromboembolic disease is common in coronavirus disease-2019 (COVID-19). There is limited evidence on the association of in-hospital anticoagulation (AC) with outcomes and postmortem findings.

OBJECTIVES:

The purpose of this study was to examine association of AC with in-hospital outcomes and describe thromboembolic findings on autopsies.

METHODS:

This retrospective analysis examined the association of AC with mortality, intubation, and major bleeding. Subanalyses were also conducted on the association of therapeutic versus prophylactic AC initiated ≤48 h from admission. Thromboembolic disease was contextualized by premortem AC among consecutive autopsies.

RESULTS:

Among 4,389 patients, median age was 65 years with 44% women. Compared with no AC (n = 1,530; 34.9%), therapeutic AC (n = 900; 20.5%) and prophylactic AC (n = 1,959; 44.6%) were associated with lower in-hospital mortality (adjusted hazard ratio [aHR] 0.53; 95% confidence interval [CI] 0.45 to 0.62 and aHR 0.50; 95% CI 0.45 to 0.57, respectively), and intubation (aHR 0.69; 95% CI 0.51 to 0.94 and aHR 0.72; 95% CI 0.58 to 0.89, respectively). When initiated ≤48 h from admission, there was no statistically significant difference between therapeutic (n = 766) versus prophylactic AC (n = 1,860) (aHR 0.86; 95% CI 0.73 to 1.02; p = 0.08). Overall, 89 patients (2%) had major bleeding adjudicated by clinician review, with 27 of 900 (3.0%) on therapeutic, 33 of 1,959 (1.7%) on prophylactic, and 29 of 1,530 (1.9%) on no AC. Of 26 autopsies, 11 (42%) had thromboembolic disease not clinically suspected and 3 of 11 (27%) were on therapeutic AC.

CONCLUSIONS:

AC was associated with lower mortality and intubation among hospitalized COVID-19 patients. Compared with prophylactic AC, therapeutic AC was associated with lower mortality, although not statistically significant. Autopsies revealed frequent thromboembolic disease. These data may inform trials to determine optimal AC regimens.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Autopsy / Thromboembolism / Coronavirus Infections / Post-Exposure Prophylaxis / Pandemics / Hospitalization / Anticoagulants Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Am Coll Cardiol Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Autopsy / Thromboembolism / Coronavirus Infections / Post-Exposure Prophylaxis / Pandemics / Hospitalization / Anticoagulants Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Am Coll Cardiol Year: 2020 Document Type: Article