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Anticoagulation in COVID-19: Effect of Enoxaparin, Heparin, and Apixaban on Mortality.
Billett, Henny H; Reyes-Gil, Morayma; Szymanski, James; Ikemura, Kenji; Stahl, Lindsay R; Lo, Yungtai; Rahman, Shafia; Gonzalez-Lugo, Jesus D; Kushnir, Margarita; Barouqa, Mohammad; Golestaneh, Ladan; Bellin, Eran.
  • Billett HH; Division of Hematology, Departments of Oncology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Reyes-Gil M; Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Szymanski J; Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Ikemura K; Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Stahl LR; Montefiore Information Technology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Lo Y; Department of Epidemiology and Population Health and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Rahman S; Division of Hematology, Departments of Oncology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Gonzalez-Lugo JD; Division of Hematology, Departments of Oncology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Kushnir M; Division of Hematology, Departments of Oncology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Barouqa M; Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Golestaneh L; Division of Nephrology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
  • Bellin E; Department of Epidemiology and Population Health and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
Thromb Haemost ; 120(12): 1691-1699, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-926367
ABSTRACT

BACKGROUND:

Mortality in coronavirus disease of 2019 (COVID-19) is associated with increases in prothrombotic parameters, particularly D-dimer levels. Anticoagulation has been proposed as therapy to decrease mortality, often adjusted for illness severity.

OBJECTIVE:

We wanted to investigate whether anticoagulation improves survival in COVID-19 and if this improvement in survival is associated with disease severity.

METHODS:

This is a cohort study simulating an intention-to-treat clinical trial, by analyzing the effect on mortality of anticoagulation therapy chosen in the first 48 hours of hospitalization. We analyzed 3,625 COVID-19+ inpatients, controlling for age, gender, glomerular filtration rate, oxygen saturation, ventilation requirement, intensive care unit admission, and time period, all determined during the first 48 hours.

RESULTS:

Adjusted logistic regression analyses demonstrated a significant decrease in mortality with prophylactic use of apixaban (odds ratio [OR] 0.46, p = 0.001) and enoxaparin (OR = 0.49, p = 0.001). Therapeutic apixaban was also associated with decreased mortality (OR 0.57, p = 0.006) but was not more beneficial than prophylactic use when analyzed over the entire cohort or within D-dimer stratified categories. Higher D-dimer levels were associated with increased mortality (p < 0.0001). When adjusted for these same comorbidities within D-dimer strata, patients with D-dimer levels < 1 µg/mL did not appear to benefit from anticoagulation while patients with D-dimer levels > 10 µg/mL derived the most benefit. There was no increase in transfusion requirement with any of the anticoagulants used.

CONCLUSION:

We conclude that COVID-19+ patients with moderate or severe illness benefit from anticoagulation and that apixaban has similar efficacy to enoxaparin in decreasing mortality in this disease.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pyrazoles / Pyridones / Blood Coagulation / Heparin / Enoxaparin / SARS-CoV-2 / COVID-19 Drug Treatment / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Thromb Haemost Year: 2020 Document Type: Article Affiliation country: S-0040-1720978

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pyrazoles / Pyridones / Blood Coagulation / Heparin / Enoxaparin / SARS-CoV-2 / COVID-19 Drug Treatment / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Thromb Haemost Year: 2020 Document Type: Article Affiliation country: S-0040-1720978