Study provides more data on the effectiveness of blood diluents for COVID-19

Earlier in the COVID-19 pandemic, researchers at Mount Sinai first showed that anticoagulant therapy was associated with improved survival in hospitalized COVID-19 patients. However, many questions remained about the magnitude of the potential benefit and which dose of this therapy would be more effective. The research team is currently proposing some possible answers in an online paper published August 26th. Journal of the American College of Cardiology..

with this Observational studyThe researchers found that all anticoagulant regimens (drugs that prevent blood coagulation) were far superior to no anticoagulants in COVID-19 patients. More specifically, “therapeutic” or full dose patients and “prophylactic” or lower dose patients have about a 50% higher survival rate and intubation than those without anticoagulants. The chances are about 30% lower. .. The researchers examined six different anticoagulant therapies, including both oral and intravenous administration, in both treatment and prevention groups. They observed that therapeutic and prophylactic subcutaneous low molecular weight heparin and therapeutic oral apixaban could lead to better results.

“This study from the Mount Sinai COVID Informatics Center provides additional insight into the role of anticoagulant therapy in the management of patients admitted with COVID-19. This is an observational study, but a large international “The randomized trials focus on three antithrombotic therapies: therapeutic and prophylactic subcutaneous low molecular weight heparin and therapeutic oral apixaban,” said Senior Response Author Valentin Fuster. She is the doctor at Sinai Heart and Mount Sinai Hospital.

This study is an extension of Mount Sinai’s study showing that treatment with anticoagulants was associated with improved outcomes in and out of the intensive care unit in hospitalized COVID-19 patients. This work was inspired by the discovery that many patients hospitalized with COVID-19 developed high levels of life-threatening ones. Blood clot..

The research team will be working on five New York City Mount Sinai Health System hospitals (Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, Mount Sinai Queens, and Mount Sinai Brooklyn) from March 1, 2020. During April 30 Mortality Comparison of patients receiving therapeutic and prophylactic anticoagulants (oral antithrombotic, subcutaneous heparin, intravenous heparin) with those not receiving anticoagulants.

Researchers used hazard scores to estimate mortality risk. Before assessing the efficacy of anticoagulant therapy, we considered relevant risk factors such as age, ethnicity, pre-existing condition, and whether the patient was already on anticoagulant. The researchers also modified to take into account the severity of diseases such as hypoxia saturation and intubation.

Of the patients analyzed, 900 (20.5%) received a full therapeutic dose of anticoagulant. Another 1,959 patients (44.6 percent) received a prophylactically lower dose of anticoagulant, and 1,530 patients (34.5 percent) received no anticoagulant. Both therapeutic and prophylactic doses of anticoagulants reduced mortality by approximately 50% compared to patients without anticoagulants.

Overall, 467 (10.6%) of the patients required intubation and mechanical ventilation during hospitalization. Patients using therapeutic anticoagulants had 31% fewer intubations than patients not using anticoagulants and 28% fewer patients using prophylactic anticoagulants. It was.

The bleeding rate, a known complication of hemodiluents, is surprisingly low overall (3% or less) in all patients, but slightly higher in the treatment group than in the prophylaxis and non-hemodilution groups, according to the researchers .. Their findings suggest that clinicians should evaluate patients individually, considering the tradeoffs between benefit and risk.

Separately, researchers examined autopsy results for 26 COVID-19 patients, 11 of whom (42%) blood Thrombus (lung, brain, heart) that was never suspected in clinical practice. These findings suggest that treating patients with anticoagulants may be associated with improved survival.

“This report is much more detailed than the previous brief report and includes more patients, longer follow-up, and rigorous methodologies. Clearly, anticoagulant therapy is associated with improved outcomes. , Bleeding rates seem to be low,” said the corresponding author, Anu. Dr. Lara, Associate Professor of Medicine (Cardiology), Director of Heart Failure Research at Ikhan School of Medicine in Mount Sinai. “As a clinician who has been at the forefront of treating COVID-19 patients, we recognize the importance of having an answer as to what is the optimal treatment for these patients. Impacts the design of clinical trials that provide relevant information.”

“These observational analyzes are performed with the highest level of statistical rigor and provide exciting insights into the association of anticoagulant therapy with significant in-hospital outcomes of mortality and intubation.” Mount Sinai COVID Informatics Center and Mount Sinai Clinical Director of the Hasso Plattner Institute for Digital Health at “We are pleased that the results of this observational study in one of the largest and most diverse hospital populations have led to ongoing trials of anticoagulant therapy types, durations and doses. Hopefully, this work will lead to improved COVID outcomes and improved treatment.-19 patients.”

“This study underscores the need for a better understanding of disease from a diagnostic and therapeutic perspective and the importance of conducting well-designed diagnostic and interventional studies,” said co-author Dr. Zahi Fayad. Describes the co-founder of Mount. Director of the Sinai COVID Informatics Center and the Biomedical Engineering and Imaging Institute of Mount Sinai.