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[Preprint]. 2021 Jan 15:2021.01.12.21249577.
doi: 10.1101/2021.01.12.21249577.

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

Matthew L Meizlish  1 , George Goshua  2 , Yiwen Liu  3 , Rebecca Fine  4 , Kejal Amin  5 , Eric Chang  2 , Nicholas DeFilippo  5   6 , Craig Keating  7 , Yuxin Liu  2 , Michael Mankbadi  4 , Dayna McManus  5 , Stephen Wang  4 , Christina Price  8 , Robert D Bona  2 , Cassius Iyad Ochoa Chaar  9 , Hyung J Chun  10 , Alexander B Pine  2 , Henry M Rinder  2   11 , Jonathan Siner  12 , Donna S Neuberg  3 , Kent A Owusu  5   13 , Alfred Ian Lee  2
Affiliations

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

Matthew L Meizlish et al. medRxiv. .

Update in

Abstract

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.

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Conflict of interest statement

Summary conflict of interest statements: No conflict of interest exists for any author on this manuscript.

Figures

Figure 1.
Figure 1.. Cumulative incidence of in-hospital death among propensity score-matched patients in the anticoagulation cohort, comparing intermediate- versus prophylactic-dose anticoagulation.
Patients were propensity score matched for age, maximum D-dimer level, admission Rothman Index score, body mass index, and African-American race using a random number seed and a caliper width of 0.25. P values from Gray’s test describe differences in cumulative incidence function between intermediate- and prophylactic-dose anticoagulation groups.
Figure 2.
Figure 2.. Cumulative incidence of in-hospital death among propensity score-matched patients in the aspirin cohort admitted after May 18, 2020, comparing in-hospital aspirin versus no antiplatelet therapy.
Patients were propensity score matched for age, maximum D-dimer level, and admission Rothman Index score. P values from Gray’s test describe differences in cumulative incidence function between patients who received in-hospital aspirin and those who did not.
See this image and copyright information in PMC

References

    1. Al-Samkari H, Karp Leaf RS, Dzik WH, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood 2020;136:489–500. - PMC - PubMed
    1. Kashi M, Jacquin A, Dakhil B, et al. Severe arterial thrombosis associated with Covid-19 infection. Thromb Res 2020;192:75–7. - PMC - PubMed
    1. Merkler AE, Parikh NS, Mir S, et al. Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza. JAMA Neurol 2020. - PMC - PubMed
    1. Carsana L, Sonzogni A, Nasr A, et al. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect Dis 2020;20:1135–40. - PMC - PubMed
    1. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020;383:120–8. - PMC - PubMed

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