Blood thinners once again associated with hospital survival at COVID-19

Anticoagulant therapy in patients admitted with COVID-19 was associated with a lower risk of death or intubation in an observational study from the New York City pandemic peak.

In-hospital mortality risk was adjusted to 50% lower with standard prophylaxis and 47% lower with higher therapeutic levels, both adjusted for other factors, both adjusted for other factors. It was statistically significant when compared to COVID-19 patients in the hospital (mortality rates were 21.6%, 28.6%, and 25.6%, respectively).

Intubation was similar in COVID-19 patients treated with anticoagulants (HR 0.69 adjusted for prophylaxis, 95% CI 0.51-0.94, and aHR 0.72 for treatment, 95% CI 0.58-0.89), Anuradha Lala, MD reported. Colleagues of the Ikern School of Medicine in Mount Sinai, New York City In Journal of the American College of Cardiology..

The predominant bleeding events adjudicated by clinician chart reviews were 1.7% (33 of 1,959) for prophylactic anticoagulation and 3% (27 of 900) for curative anticoagulation. It was 1.9% (29 of 1,530) without the coagulant. Hospitalization.

“The retrospective nature of this study has severe limitations,” warned Dr. Stephan Moll of the Center for Hemophilia and Thrombosis at the University of North Carolina at Chapel Hill.

“But a prospective study of inpatients and outpatients with NIH [prophylaxis] A comparison of different anticoagulant management strategies is planned, and hopefully in the near future, all these retrospective studies and data from the last few months will be available. MedPage today..

Lara’s group had Previously reported Experience with anticoagulant therapy in 2,773 patients treated early in a pandemic revealed the superiority of in-hospital survival with a therapeutic dose of anticoagulant therapy and long-term anticoagulant therapy in ventilated patients.

Subsequent research suggested Increased mortality risk Preemptive dose of anticoagulant therapy in COVID-19 patients.

New data include 4389 adults with laboratory-confirmed SARS-CoV-2 infection from 1 March to 30 April 2020 in five New York City hospitals on Mount Sinai System. It was.

The researchers conservatively classified people treated with anticoagulants for less than 48 hours as being in the control group unless the drug was discontinued due to major bleeding. Patients who were discharged within 24 hours and who were treated with both treatment and prevention regimens were excluded.

The study also evaluated the first 26 autopsies of COVID-19 patients in the healthcare system, which caused thromboembolism in 11 (42%), but only one was suspected before death. It was being appreciated. “Our findings are consistent with what other studies have shown,” Lara said. “We see more blood clots than ever suspected.”

All said that 34.9% of patients with COVID-19 were not on anticoagulant therapy. These patients may have been treated early in a pandemic with altered practices, Lara noted an increase in observational data supporting prophylactic anticoagulant therapy. But the main factor seems to be less severe, she said.

Nonetheless, there is plenty of data from previous randomized trials supporting pharmacological thromboprophylaxis, making it the standard of care in the hospital, regardless of COVID-19. Involved in COVID-related anticoagulant consensus recommendations and clinical trials.

“Thanks that God New York is not under the control of COVID, as this study has been completed. I hope it remains that way. But if the patient comes in front of me I’m inclined to think about how to treat patients, nevertheless, I think doses and drugs need to be confirmed in clinical trials,” Lara agreed.

The current study has a better explanation of methodologies and a more corroborative analysis that makes results more reliable than previous studies from the organization, but the trial Inspiration And that NIH ACTIV Mr. Vickeli said he would really be the one who provided the answer.

“The question they’re trying to answer may be one of the three or four key questions we face as clinicians treating COVID-19,” he said. MedPage today..