TY - JOUR
T1 - Anticoagulation in COVID-19
T2 - Effect of Enoxaparin, Heparin, and Apixaban on Mortality
AU - Billett, Henny H.
AU - Reyes-Gil, Morayma
AU - Szymanski, James
AU - Ikemura, Kenji
AU - Stahl, Lindsay R.
AU - Lo, Yungtai
AU - Rahman, Shafia
AU - Gonzalez-Lugo, Jesus D.
AU - Kushnir, Margarita
AU - Barouqa, Mohammad
AU - Golestaneh, Ladan
AU - Bellin, Eran
N1 - Publisher Copyright:
© 2020 Georg Thieme Verlag. All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - D-dimer
KW - anticoagulation
KW - apixaban
KW - enoxaparin
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85096439371&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85096439371&partnerID=8YFLogxK
U2 - 10.1055/s-0040-1720978
DO - 10.1055/s-0040-1720978
M3 - Article
C2 - 33186991
AN - SCOPUS:85096439371
SN - 0340-6245
VL - 120
SP - 1691
EP - 1699
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 12
ER -