Abstract Number: LPB0056
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: A high incidence of venous thromboembolism (VTE) is observed in patients with COVID-19. Furthermore, several studies show that hypercoagulability is associated with mortality.
Aims: To investigate whether pre-admission anticoagulant therapy is associated with a lower risk of all-cause mortality in hospitalized COVID-19 patients.
Methods: Retrospective data from 1,851 consecutive patients with PCR-confirmed SARS-CoV-2 infection hospitalized in eight Dutch centres between February 27th and August 1st 2020 were used. During this period, Dutch guidelines recommended routine thromboprophylaxis for all hospitalized COVID-19 patients.
After 1:1 propensity score nearest-neighbour matching based on age, sex, and 17 comorbidities, the association between pre-admission anticoagulant therapy for VTE, atrial fibrillation, or other indications (i.e. direct oral anticoagulants or vitamin K antagonists) and all-cause mortality and intensive care unit (ICU) admission was evaluated.
A secondary analysis was performed with a broader definition of antithrombotic therapy including anticoagulants and antiplatelet drugs.
Results: Mean age was 66.4 years (SD, 14.8) and 39% were women. Pre-admission, 678 patients (37%) were using anticoagulant and/or antiplatelet therapy of whom 287 (16%) used anticoagulant therapy only, 408 (22%) antiplatelet therapy only, and 17 both anticoagulant and antiplatelet therapy. 253 anticoagulant users and 253 patients not using therapeutic anticoagulation were matched.
During a median follow-up of 21 days [IQR: 9.8-21.0], anticoagulant therapy was neither associated with all-cause mortality (hazard ratio [HR], 0.95; 95%-CI, 0.70-1.27; Figure 1) nor with ICU admission (HR, 1.0; 95%-CI, 0.59-1.70). Results did not materially change in the secondary analysis of anticoagulant and/or antiplatelet therapy (HR for mortality, 1.18 [95%-CI, 0.87-1.59] and HR for ICU admission, 2.98 [95%-CI, 0.60-1.39]).
Total population n = 1851 | Anticoagulant use (n = 287) |
No anticoagulant use (n = 1564) |
p-value | Standardized mean difference | Anticoagulant use (n = 253) |
No anticoagulant use (n = 253) |
p-value | Standardized mean difference |
---|---|---|---|---|---|---|---|---|
Age*, years mean (SD) | 76.75 (10.36) | 64.54 (14.75) | <0.001 | 0.957 | 76.47 (16.00) | 75.89 (10.10) | 0.523 | 0.012 |
Time in pandemic* in days, mean (SD) | 45.69 (15.56) | 46.88 (16.37) | 0.253 | 0.075 | 45.55 (15.28) | 46.96 (16.21) | 0.419 | 0.071 |
Women*, n (%) | 98 (34) | 615 (39) | 0.112 | 0.108 | 89 (35) | 91 (36) | 1.000 | 0.008 |
Diabetes*, n (%) | 100 (35) | 382 (25) | <0.001 | 0.228 | 89 (35) | 100 (39) | 0.359 | 0.008 |
Asthma*, n (%) | 21 (7) | 171 (11) | 0.077 | 0.128 | 20 (8) | 23 (9) | 0.750 | 0.045 |
Obesity*, n (%) | 85 (32) | 439 (30) | 0.726 | 0.028 | 81 (32) | 87 (34) | 0.571 | 0.043 |
Hypertension, n (%) | 168 (59) | 684 (44) | <0.001 | 0.296 | 152 (60) | 156 (62) | 0.785 | 0.032 |
Temperature at admission in °C, mean (SD) | 37.68 (1.28) | 37.82 (1.16) | 0.062 | 0.116 | 37.70 (1.31) | 37.81 (1.24) | 0.308 | 0.091 |
Oxygen saturation in %, mean (SD) | 93.2 (6.38) | 93.1 (5.85) | 0.737 | 0.021 | 93.3 (6.44) | 92.9 (5.85) | 0.453 | 0.067 |
Conclusions: In this retrospective cohort study, pre-admission anticoagulant use was not associated with a lower risk of mortality or ICU admission in hospitalized COVID-19 patients.
Further data from randomized controlled trials are needed to determine the risk-benefit ratio of initiating anticoagulant therapy during admission for COVID-19.
To cite this abstract in AMA style:
van Haaps TF, Collard D, Middeldorp S, Coppens M, de Kruif MD, ten Cate H, Tuinman PR, Douma RA, Muller MC, Reidinga AC, Heuvelmans MA, Oudkerk M, van Osch FH, van den Bergh JP, Maas A, Gritters N, Ten Wolde M, Juffermans NP, van Es N, on behalf of the Dutch COVID & Thrombosis Coalition . Pre-admission Anticoagulant Therapy and Mortality in Hospitalized COVID-19 Patients: A Covid Predict Retrospective Cohort Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/pre-admission-anticoagulant-therapy-and-mortality-in-hospitalized-covid-19-patients-a-covid-predict-retrospective-cohort-study/. Accessed March 22, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pre-admission-anticoagulant-therapy-and-mortality-in-hospitalized-covid-19-patients-a-covid-predict-retrospective-cohort-study/