| Popis: |
Rationale: SARS-CoV-2 has been associated with increased risk for thrombotic disease and respiratory failure. Therapeutic or intermediate dose anticoagulation has been associated with decreased thrombotic events and potentially improved hospital outcomes. It is not known whether this potential benefit of anticoagulation is unique to SARS-CoV-2, or if this is shared with other respiratory viruses. Our study compared chronic therapeutic anticoagulation use to non-chronic anticoagulation in hospitalized patients with SARS-CoV-2 and Influenza. Methods: This was a retrospective single center study with IRB approval. Patients were included if they were >18 years old and admitted to the University of Rochester Medical Center or affiliate with either a SARS-CoV-2 or Influenza (A/B) positive test between September 1 2019 and September 1 2020. Patients were identified using medical records and manually validated for accuracy. Chronic therapeutic anticoagulation was defined as anticoagulation >30 days prior to infection diagnosis. Baseline characteristics, reason for hospitalization, laboratory, degree of hypoxia, ICU admission, ICU management strategies, thrombotic complications, bleeding complications, in hospital, and 90 day mortality were collected. Parametric and non-parametric t-test were used. Results:A total of 495 patients were admitted with a positive SARS-CoV-2 PCR with 65 patients (13.1%) on chronic therapeutic anticoagulation. During hospitalization, 60 patients continued full dose anticoagulation and five received enhanced prophylaxis. 103 of the non-chronically anticoagulated received enhanced prophylaxis and the remaining received standard dosing. 429 patients were admitted with a positive influenza PCR with 56 (13.1%) on chronic therapeutic anticoagulation. Chronically anticoagulated patients in the SARS-CoV-2 and influenza group were significantly older, 75 (67,84) vs 65 (50, 76) and 73 (60,78) vs 60 (40, 71) respectively. Despite being older, there was no difference in inflammatory markers, respiratory failure, intubation, ICU admission, shock, or acute renal failure requiring renal replacement (Table 1). Chronically anticoagulated SARS-CoV-2 patients had 1 venous thrombotic event while the non-chronically anticoagulated patients, including enhanced prophylaxis, had 27 events (Table 1). Conclusion We found that chronic therapeutic anticoagulation may decrease severity of illness in both SARS-CoV-2 and influenza infection. In both groups the chronically anticoagulated patients were significantly older with increased comorbidities and despite that they did not have more significant disease. Our hospital system was not overwhelmed during this time and a significant number of COVID deaths were patients who opted for limited interventions. Further studies are warranted on the impact of anticoagulation with respiratory viruses. (Table Presented). |
