Abstract Number: PB/CO16
Meeting: ISTH 2020 Congress
Background: Mortality in COVID-19 is associated with increases in prothrombotic parameters, particularly D-Dimer levels. Many institutions have adopted anticoagulation guidelines, often adjusted for illness severity.
Aims: We wanted to investigate whether anticoagulation improves survival in COVID-19.
Methods: We analyzed the results of anticoagulation therapeutic intent in the first 48 hours of hospitalization to imitate therapy assignment of a clinical trial with subsequent outcome attributed to that assignment, an observational intention to treat analysis.
Results: We analyzed 3,842 COVID+ inpatients for mortality based on therapeutic anticoagulant choice. We controlled for age, GFR, oxygen saturation, ventilation requirement and time period, all determined during the first 48 hours. Patients on other clinical trials were excluded (n=305). When adjusted and then stratified by D-Dimer level, apixaban prophylaxis was associated with decreased mortality for D-Dimer levels 1-3ug/ml [OR: 0.43 (95%CI 0.21 – 0.89), p=0.022] while apixaban therapy was beneficial for those with higher D-Dimers levels of >10ug/ml [OR: 0.26 (95%CI:0.10-0.72), p =0.009]. Neither enoxaparin nor unfractionated heparin at prophylaxis or therapeutic doses was associated with decreased mortality at any D-Dimer level while full enoxaparin therapy was associated with increased mortality at D-Dimers < 1 ug/ml. [OR 14.75 (95%CI:1.80-120.78), p=0.012]. Adjusted analysis of the entire population with all comorbidities and D-Dimer in the model showed that only apixaban prophylaxis was associated with decreased mortality [OR:0.52(95%CI:0.31-0.87) p< 0.013].
Conclusions: We conclude that patients with COVID, particularly those with severe illness, benefit from D-Dimer-dependent anticoagulation and that apixaban is effective in decreasing mortality in this disease.
To cite this abstract in AMA style:Billett H, Reyes Gil M, Szymanski J, Ikemura K, Stahl L, Lo Y, Rahman S, Gonzalez Lugo J, Kushnir M, Barouqa M, Golestaneh L, Bellin E. The Effect of Anticoagulation on Mortality in COVID-19 Patients: The Drug, the Dose, and the D-Dimer [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-effect-of-anticoagulation-on-mortality-in-covid-19-patients-the-drug-the-dose-and-the-d-dimer/. Accessed September 16, 2021.
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