Chronic anti-coagulation therapy reduced mortality in patients with high cardiovascular risk early in COVID-19 pandemic

Thrombosis Journal

Research

Qianjin Liu¹  Suhong Luo²  Momodou Jammeh³  Mohamed S. Zaghloul³  Yan Yan⁴  Kelley Chadwick-Mansker⁴  Mohamed A. Zayed⁵  Andrew Gibson⁶ 

[1] Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA;Department of Hematology, Washington University School of Medicine, St. Louis, MO, USA;Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, 63110-1093, St. Louis, MO, USA;Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, 63110-1093, St. Louis, MO, USA;Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA;Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, 63110-1093, St. Louis, MO, USA;Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA;Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA;Division of Molecular Cell Biology, Washington University School of Medicine, St. Louis, MO, USA;Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, MO, USA;Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA;

关键词: COVID-19;    Anti-coagulation therapy;    Multi-organ system complications;    In-hospital death;    Intensive care unit death;   

DOI  :  10.1186/s12959-023-00460-z

 received in 2022-11-20, accepted in 2023-01-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCoronavirus disease 2019 (COVID-19) is associated with provoked thrombo-inflammatory responses. Early in the COVID-19 pandemic this was thought to contribute to hypercoagulability and multi-organ system complications in infected patients. Limited studies have evaluated the impact of therapeutic anti-coagulation therapy (AC) in alleviating these risks in COVID-19 positive patients. Our study aimed to investigate whether long-term therapeutic AC can decrease the risk of multi-organ system complications (MOSC) including stroke, limb ischemia, gastrointestinal (GI) bleeding, in-hospital and intensive care unit death in COVID-19 positive patients hospitalized during the early phase of the pandemic in the United States.MethodsA retrospective analysis was conducted of all COVID-19 positive United States Veterans between March 2020 and October 2020. Patients receiving continuous outpatient therapeutic AC for a least 90 days prior to their initial COVID-19 positive test were assigned to the AC group. Patients who did not receive AC were included in a control group. We analyzed the primary study outcome of MOSC between the AC and control groups using binary logistic regression analysis (Odd-Ratio; OR).ResultsWe identified 48,066 COVID-19 patients, of them 879 (1.8%) were receiving continuous therapeutic AC. The AC cohort had significantly worse comorbidities than the control group. On the adjusted binary logistic regression model, therapeutic AC significantly decreased in-hospital mortality rate (OR; 0.67, p = 0.04), despite a higher incidence of GI bleeding (OR; 4.00, p = 0.02). However, therapeutic AC did not significantly reduce other adverse events.ConclusionAC therapy reduced in-hospital death early in the COVID-19 pandemic among patients who were hospitalized with the infection. However, it did not decrease the risk of MOSC. Additional trials are needed to determine the effectiveness of AC in preventing complications associated with ongoing emerging strains of the COVID-19 virus.

【 授权许可】

CC BY   
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023

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