Association of Anticoagulation Dose and Survival in Hospitalized COVID-19 Patients: A Retrospective Propensity Score Weighted Analysis

Eur J Haematol. 2020 Oct 11. doi: 10.1111/ejh.13533. Online ahead of print.

Abstract

Background: Hypercoagulability may contribute to COVID-19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear.

Objectives: We evaluated the impact on survival of different AC doses in COVID-19 patients.

Methods: Retrospective, multi-center cohort study of consecutive COVID-19 patients hospitalized between March 13th and May 5th, 2020.

Results: 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n=642) required intensive care unit (ICU) stay. 60.9% received pAC (n=2121), 28.7% received ≥3 days of tAC (n=998), and 10.4% (n=361) received no AC. Propensity score (PS) weighted Kaplan-Meier plot demonstrated different 25-day survival probability in the tAC and pAC groups (57.5% vs 50.7%). In a PS weighted multivariate proportional hazards model, AC was associated with reduced risk of death at prophylactic (hazard ratio [HR] 0.35 [95% confidence interval {CI} 0.22-0.54]) and therapeutic doses (HR 0.14 [95% CI 0.05-0.23]) compared to no AC. Major bleeding occurred more frequently in tAC patients (81 [8.1%]) compared to no AC (20 [5.5%]) or pAC (46 [2.2%]) subjects.

Conclusions: Higher doses of AC were associated with lower mortality in hospitalized COVID-19 patients. Prospective evaluation of efficacy and risk of AC in COVID-19 is warranted.

Keywords: Anticoagulation; COVID-19; Heparin; Novel coronavirus.