Oral anticoagulation and clinical outcomes in COVID-19: An Italian multicenter experience

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:323

Article

Schiavone, Marco¹  Gasperetti, Alessio¹  Mancone, Massimo²  Curnis, Antonio^3,4  Mascioli, Giosue⁵  Mitacchione, Gianfranco¹  Busana, Mattia⁶  Sabato, Federica¹  Gobbi, Cecilia⁷  Antinori, Spinello^8,9  Galli, Massimo^8,9  Forleo, Giovanni Battista¹ 

[1] Luigi Sacco Univ Hosp, Dept Cardiol, ASST Fatebenefratelli Sacco, Milan, Italy

[2] Sapienza Univ Rome, Dept Clin Internal Anesthesiol & Cardiovasc Sci, Rome, Italy

[3] Univ Brescia, Inst Cardiol, ASST Spedali Civili Brescia, Brescia, Italy

[4] Univ Brescia, Dept Med & Surg Specialties, Radiol Sci & Publ Hlth, Brescia, Italy

[5] Humanitas Gavazzeni Hosp, Cardiovasc Dept, Bergamo, Italy

[6] Univ Gottingen, Dept Anesthesiol Emergency & Intens Care Med, Gottingen, Germany

[7] Univ Milan, Milan, Italy

[8] Luigi Sacco Univ Hosp, Dept Infect Dis, ASST Fatebenefratelli Sacco, Milan, Italy

[9] Univ Milan, Luigi Sacco Dept Biomed & Clin Sci DIBIC, Milan, Italy

关键词: Anticoagulation;    Oral anticoagulants;    Heparin;    Microthrombosis;    Coagulopathy;    COVID-19;   

DOI  :  10.1016/j.ijcard.2020.09.001

来源: Elsevier

【 摘 要 】

Background: Since the body of evidence addressing the coagulation derangements caused by Coronavirus disease (COVID-19) has been constantly growing, we investigated whether pre-hospitalization oral anticoagulation (OAC) or in-hospital heparin treatment could have a protective role among COVID-19 patients. Method: In this cohort study, consecutive COVID-19 patients admitted to four different Italian Institutions were enrolled. Baseline demographic, clinical, laboratory, and radiological characteristics, as well as in-hospital treatment and outcomes were evaluated. The primary outcome was mortality. Results: A total of 844 COVID-19 patients were enrolled as study cohort, n = 65 (7.7%) taking OACs prior to hospitalization. Regarding clinical outcomes, OAC patients developed acute hypoxemic respiratory failure (AHRF) more frequently than non-OAC patients as well as presenting a higher mortality rate (44.6% vs 19.8%, p < 0.001). At overall multivariate logistical regression, use of heparin (n = 394, 46.6%) was associated with a better chance of survival to hospital discharge (OR 0.60 [0.38-0.94], p < 0.001), in particular in patients with AHRF, with no association found with the use of OACs. In a sub-analysis, the highest mortality rate was found for AHRF patients when heparin was not administered. Conclusion: In our cohort, OACs appeared to be ineffective in reducing mortality rate, while heparin resulted to be a useful treatment when lung disease was sufficiently severe, potentially suggesting a crucial role of microthrombosis in severe COVID-19. Due to the relatively small number of COVID-19 patients treated with OACs included in our analysis and their higher number of comorbidities, larger studies are needed in order to confirm our findings. (C) 2020 Published by Elsevier B.V.

【 授权许可】

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