Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis.

Autor:	Meizlish ML; Yale School of Medicine, New Haven, CT., Goshua G; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT., Liu Y; Dana-Farber Cancer Institute, Boston, MA., Fine R; Department of Medicine, Yale School of Medicine, New Haven, CT., Amin K; Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT., Chang E; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT., DeFilippo N; Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT.; School of Pharmacy, University of Connecticut, Storrs, CT., Keating C; Joint Data Analytics Team, Yale New Haven Hospital, New Haven, CT., Liu Y; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT., Mankbadi M; Department of Medicine, Yale School of Medicine, New Haven, CT., McManus D; Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT., Wang S; Department of Medicine, Yale School of Medicine, New Haven, CT., Price C; Section of Allergy and Immunology, Department of Medicine, Yale School of Medicine, New Haven, CT., Bona RD; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT., Chaar CIO; Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT., Chun HJ; Section of Cardiology, Department of Medicine, Yale School of Medicine, New Haven, CT., Pine AB; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT., Rinder HM; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT.; Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT., Siner J; Section of Pulmonary and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT., Neuberg DS; Dana-Farber Cancer Institute, Boston, MA., Owusu KA; Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT.; Clinical Redesign, Yale New Haven Health, New Haven, CT., Lee AI; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2021 Jan 15. Date of Electronic Publication: 2021 Jan 15.
DOI:	10.1101/2021.01.12.21249577
Abstrakt:	Background: Thrombotic complications occur at high rates in hospitalized patients with COVID-19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. Research Question: How does in-hospital mortality compare with intermediate- versus prophylactic-dose anticoagulation, and separately with in-hospital aspirin versus no antiplatelet therapy, in treatment of COVID-19? Study Design and Methods: Using data from 2785 hospitalized adult COVID-19 patients, we established two separate, nested cohorts of patients (1) who received intermediate- or prophylactic-dose anticoagulation ("anticoagulation cohort", N = 1624), or (2) who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy ("aspirin cohort", N = 1956). Propensity score matching utilizing various markers of illness severity and other patient-specific covariates yielded treatment groups with well-balanced covariates in each cohort. The primary outcome was cumulative incidence of in-hospital death. Results: Among propensity score-matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate- compared to prophylactic-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.518 [0.308-0.872]). Among propensity-score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in-hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.522 [0.336-0.812]). Interpretation: In this propensity score-matched, observational study of COVID-19, intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death. Competing Interests: Summary conflict of interest statements: No conflict of interest exists for any author on this manuscript.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu