Observational Study

. 2021 May;174(5):622-632.

doi: 10.7326/M20-6739. Epub 2021 Jan 26.

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

Hanny Al-Samkari¹, Shruti Gupta², Rebecca Karp Leaf¹, Wei Wang³, Rachel P Rosovsky¹, Samantha K Brenner⁴, Salim S Hayek⁵, Hanna Berlin⁵, Rajat Kapoor⁶, Shahzad Shaefi⁷, Michal L Melamed⁸, Anne Sutherland⁹, Jared Radbel¹⁰, Adam Green¹¹, Brian T Garibaldi¹², Anand Srivastava¹³, Amanda Leonberg-Yoo¹⁴, Alexandre M Shehata¹⁵, Jennifer E Flythe¹⁶, Arash Rashidi¹⁷, Nitender Goyal¹⁸, Lili Chan¹⁹, Kusum S Mathews¹⁹, S Susan Hedayati²⁰, Rajany Dy²¹, Stephanie M Toth-Manikowski²², Jingjing Zhang²³, Mary Mallappallil²⁴, Roberta E Redfern²⁵, Amar D Bansal²⁶, Samuel A P Short²⁷, Mark G Vangel²⁸, Andrew J Admon²⁹, Matthew W Semler³⁰, Kenneth A Bauer³¹, Miguel A Hernán³², David E Leaf²; STOP-COVID Investigators

Collaborators, Affiliations

Collaborators

STOP-COVID Investigators:
Carl P Walther, Samaya J Anumudu, Justin Arunthamakun, Kathleen F Kopecky, Gregory P Milligan, Peter A McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Megan L Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D Valencia, Kenneth A Bauer, Sushrut S Waikar, Zoe A Kibbelaar, Ambarish M Athavale, Peter Hart, Shristi Upadhyay, Ishaan Vohra, Ajiboye Oyintayo, Adam Green, Jean-Sebastien Rachoin, Christa A Schorr, Lisa Shea, Daniel L Edmonston, Christopher L Mosher, Alexandre M Shehata, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor Ul Aain Bhatti, Bijal Mehta, Aquino Williams, Samantha K Brenner, Patricia Walters, Ronaldo C Go, Keith M Rose, Miguel A Hernán, Amy M Zhou, Ethan C Kim, Rebecca Lisk, Lili Chan, Kusum S Mathews, Steven G Coca, Deena R Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A Leven, Jing G Wang, Gohar Mosoyan, Pattharawin Pattharanitima, Emily J Gallagher, Allon N Friedman, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine J Kelly, Chirag R Parikh, Brian T Garibaldi, Celia P Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F Malik, Carmen Elena Cervantes, Samir C Gautam, Mary C Mallappallil, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, Leon Boudourakis, H Bryant Nguyen, Afshin Ahoubim, Leslie F Thomas, Dheeraj Reddy Sirganagari, Pramod K Guru, Yan Zhou, Paul A Bergl, Jesus Rodriguez, Jatan A Shah, Mrigank S Gupta, Princy N Kumar, Deepa G Lazarous, Seble G Kassaye, Michal L Melamed, Tanya S Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Jyotsana Thakkar, Neelja Kumar, Michael J Ross, Michael Chang, Ritesh Raichoudhury, Akshay Athreya, Mohamed Farag, Edward J Schenck, Soo Jung Cho, Maria Plataki, Sergio L Alvarez-Mulett, Luis G Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, David Charytan, Ashley Macina, Anand Srivastava, Alexander S Leidner, Carlos Martinez, Jacqueline M Kruser, Richard G Wunderink, Alexander J Hodakowski, Juan Carlos Q Velez, Eboni G Price-Haywood, Luis A Matute-Trochez, Anna E Hasty, Muner M B Mohamed, Rupali S Avasare, David Zonies, David E Leaf, Shruti Gupta, Rebecca Karp Leaf, Rachel Rosovsky, Meghan E Sise, Erik T Newman, Samah Abu Omar, Kapil K Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Omer Kamal, Wei Wang, Meghan Lee, Ian A Strohbehn, Jiahua Li, Ariel L Mueller, Roberta E Redfern, Nicholas S Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, Laura Bickley, Chris Rowan, Farah Madhani-Lovely, Vasil Peev, Jochen Reiser, John J Byun, Andrew Vissing, Esha M Kapania, Zoe Post, Nilam P Patel, Joy-Marie Hermes, Anne K Sutherland, Amee Patrawalla, Diana G Finkel, Barbara A Danek, Sowminya Arikapudi, Jeffrey M Paer, Peter Cangialosi, Mark Liotta, Jared Radbel, Sonika Puri, Jag Sunderram, Matthew T Scharf, Ayesha Ahmed, Ilya Berim, Jayanth S Vatson, George Karp, Shuchi Anand, Joseph E Levitt, Pablo Garcia, Suzanne M Boyle, Rui Song, Jingjing Zhang, Sang Hoon Woo, Xiaoying Deng, Goni Katz-Greenberg, Moh'd A Sharshir, Vadym V Rusnak, Muhammad Imran Ali, Anip Bansal, Amber S Podoll, Michel Chonchol, Sunita Sharma, Ellen L Burnham, Arash Rashidi, Rana Hejal, Eric Judd, Laura Latta, Ashita Tolwani, Timothy E Albertson, Jason Y Adams, Steven Y Chang, Rebecca M Beutler, Carl E Schulze, Etienne Macedo, Harin Rhee, Kathleen D Liu, Vasantha K Jotwani, Jay L Koyner, Chintan V Shah, Vishal Jaikaransingh, Stephanie M Toth-Manikowski, Min J Joo, James P Lash, Javier A Neyra, Nourhan Chaaban, Madona Elias, Yahya Ahmad, Rajany Dy, Alfredo Iardino, Elizabeth H Au, Jill H Sharma, Marie Anne Sosa, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Hayley B Gershengorn, Alessia Fornoni, Salim S Hayek, Pennelope Blakely, Hanna Berlin, Tariq U Azam, Husam Shadid, Michael Pan, Patrick O'Hayer, Chelsea Meloche, Rafey Feroze, Kishan J Padalia, Jeff Leya, John P Donnelly, Andrew J Admon, Jennifer E Flythe, Matthew J Tugman, Emily H Chang, Brent R Brown, Amanda K Leonberg-Yoo, Ryan C Spiardi, Todd A Miano, Meaghan S Roche, Charles R Vasquez, Amar D Bansal, Natalie C Ernecoff, Sanjana Kapoor, Siddharth Verma, Huiwen Chen, Csaba P Kovesdy, Miklos Z Molnar, Ambreen Azhar, S Susan Hedayati, Mridula V Nadamuni, Shani Shastri, Duwayne L Willett, Samuel A P Short, Amanda D Renaghan, Kyle B Enfield, Pavan K Bhatraju, A Bilal Malik, Matthew W Semler, Anitha Vijayan, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F Kao, Greg L Schumaker, Nitender Goyal, Anthony J Faugno, Greg L Schumaker, Caroline M Hsu, Asma Tariq, Leah Meyer, Ravi K Kshirsagar, Daniel E Weiner, Marta Christov, Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, Savneek Chugh, Perry Wilson, Tanima Arora, Ugochukwu Ugwuowo

Affiliations

¹ Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (H.A., R.K.L., R.P.R.).
² Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.G., D.E.L.).
³ Brigham and Women's Hospital, Boston, Massachusetts (W.W.).
⁴ Heart and Vascular Hospital, Hackensack Meridian Health Hackensack University Medical Center, Hackensack, New Jersey (S.K.B.).
⁵ University of Michigan Medical Center, Ann Arbor, Michigan (S.S.H., H.B.).
⁶ Indiana University School of Medicine, Indianapolis, Indiana (R.K.).
⁷ Beth Israel Deaconess Medical Center, Boston, Massachusetts (S.S.).
⁸ Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.L.M.).
⁹ Rutgers New Jersey Medical School, Newark, New Jersey (A.S.).
¹⁰ Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.R.).
¹¹ Cooper University Health Care, Camden, New Jersey (A.G.).
¹² Johns Hopkins School of Medicine, Baltimore, Maryland (B.T.G.).
¹³ Center for Translational Metabolism and Health, Institute for Public Health and Medicine, and Northwestern University Feinberg School of Medicine, Chicago, Illinois (A.S.).
¹⁴ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.L.).
¹⁵ Hackensack Meridian Health Mountainside Medical Center, Glen Ridge, New Jersey (A.M.S.).
¹⁶ University of North Carolina Kidney Center, UNC School of Medicine, and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina (J.E.F.).
¹⁷ University Hospitals Cleveland Medical Center, Cleveland, Ohio (A.R.).
¹⁸ Tufts Medical Center, Boston, Massachusetts (N.G.).
¹⁹ Icahn School of Medicine at Mount Sinai, New York, New York (L.C., K.S.M.).
²⁰ University of Texas Southwestern Medical Center, Dallas, Texas (S.S.H.).
²¹ University Medical Center of Southern Nevada Hospital, University of Nevada, Las Vegas, Nevada (R.D.).
²² University of Illinois Hospital at Chicago, Chicago, Illinois (S.M.T.).
²³ Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (J.Z.).
²⁴ Kings County Hospital Center, New York City Health and Hospital Corporation, Brooklyn, New York (M.M.).
²⁵ ProMedica Research, ProMedica Toledo Hospital, Toledo, Ohio (R.E.R.).
²⁶ University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.D.B.).
²⁷ University of Vermont Larner College of Medicine, Burlington, Vermont (S.A.S.).
²⁸ Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts (M.G.V.).
²⁹ University of Michigan, Ann Arbor, Michigan (A.J.A.).
³⁰ Vanderbilt University Medical Center, Nashville, Tennessee (M.W.S.).
³¹ Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.A.B.).
³² Harvard T.H. Chan School of Public Health and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts (M.A.H.).

PMID: 33493012
PMCID: PMC7863679
DOI: 10.7326/M20-6739

Observational Study

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

Hanny Al-Samkari et al. Ann Intern Med. 2021 May.

. 2021 May;174(5):622-632.

doi: 10.7326/M20-6739. Epub 2021 Jan 26.

Authors

Collaborators

STOP-COVID Investigators:
Carl P Walther, Samaya J Anumudu, Justin Arunthamakun, Kathleen F Kopecky, Gregory P Milligan, Peter A McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Megan L Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D Valencia, Kenneth A Bauer, Sushrut S Waikar, Zoe A Kibbelaar, Ambarish M Athavale, Peter Hart, Shristi Upadhyay, Ishaan Vohra, Ajiboye Oyintayo, Adam Green, Jean-Sebastien Rachoin, Christa A Schorr, Lisa Shea, Daniel L Edmonston, Christopher L Mosher, Alexandre M Shehata, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor Ul Aain Bhatti, Bijal Mehta, Aquino Williams, Samantha K Brenner, Patricia Walters, Ronaldo C Go, Keith M Rose, Miguel A Hernán, Amy M Zhou, Ethan C Kim, Rebecca Lisk, Lili Chan, Kusum S Mathews, Steven G Coca, Deena R Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A Leven, Jing G Wang, Gohar Mosoyan, Pattharawin Pattharanitima, Emily J Gallagher, Allon N Friedman, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine J Kelly, Chirag R Parikh, Brian T Garibaldi, Celia P Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F Malik, Carmen Elena Cervantes, Samir C Gautam, Mary C Mallappallil, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, Leon Boudourakis, H Bryant Nguyen, Afshin Ahoubim, Leslie F Thomas, Dheeraj Reddy Sirganagari, Pramod K Guru, Yan Zhou, Paul A Bergl, Jesus Rodriguez, Jatan A Shah, Mrigank S Gupta, Princy N Kumar, Deepa G Lazarous, Seble G Kassaye, Michal L Melamed, Tanya S Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Jyotsana Thakkar, Neelja Kumar, Michael J Ross, Michael Chang, Ritesh Raichoudhury, Akshay Athreya, Mohamed Farag, Edward J Schenck, Soo Jung Cho, Maria Plataki, Sergio L Alvarez-Mulett, Luis G Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, David Charytan, Ashley Macina, Anand Srivastava, Alexander S Leidner, Carlos Martinez, Jacqueline M Kruser, Richard G Wunderink, Alexander J Hodakowski, Juan Carlos Q Velez, Eboni G Price-Haywood, Luis A Matute-Trochez, Anna E Hasty, Muner M B Mohamed, Rupali S Avasare, David Zonies, David E Leaf, Shruti Gupta, Rebecca Karp Leaf, Rachel Rosovsky, Meghan E Sise, Erik T Newman, Samah Abu Omar, Kapil K Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Omer Kamal, Wei Wang, Meghan Lee, Ian A Strohbehn, Jiahua Li, Ariel L Mueller, Roberta E Redfern, Nicholas S Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, Laura Bickley, Chris Rowan, Farah Madhani-Lovely, Vasil Peev, Jochen Reiser, John J Byun, Andrew Vissing, Esha M Kapania, Zoe Post, Nilam P Patel, Joy-Marie Hermes, Anne K Sutherland, Amee Patrawalla, Diana G Finkel, Barbara A Danek, Sowminya Arikapudi, Jeffrey M Paer, Peter Cangialosi, Mark Liotta, Jared Radbel, Sonika Puri, Jag Sunderram, Matthew T Scharf, Ayesha Ahmed, Ilya Berim, Jayanth S Vatson, George Karp, Shuchi Anand, Joseph E Levitt, Pablo Garcia, Suzanne M Boyle, Rui Song, Jingjing Zhang, Sang Hoon Woo, Xiaoying Deng, Goni Katz-Greenberg, Moh'd A Sharshir, Vadym V Rusnak, Muhammad Imran Ali, Anip Bansal, Amber S Podoll, Michel Chonchol, Sunita Sharma, Ellen L Burnham, Arash Rashidi, Rana Hejal, Eric Judd, Laura Latta, Ashita Tolwani, Timothy E Albertson, Jason Y Adams, Steven Y Chang, Rebecca M Beutler, Carl E Schulze, Etienne Macedo, Harin Rhee, Kathleen D Liu, Vasantha K Jotwani, Jay L Koyner, Chintan V Shah, Vishal Jaikaransingh, Stephanie M Toth-Manikowski, Min J Joo, James P Lash, Javier A Neyra, Nourhan Chaaban, Madona Elias, Yahya Ahmad, Rajany Dy, Alfredo Iardino, Elizabeth H Au, Jill H Sharma, Marie Anne Sosa, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Hayley B Gershengorn, Alessia Fornoni, Salim S Hayek, Pennelope Blakely, Hanna Berlin, Tariq U Azam, Husam Shadid, Michael Pan, Patrick O'Hayer, Chelsea Meloche, Rafey Feroze, Kishan J Padalia, Jeff Leya, John P Donnelly, Andrew J Admon, Jennifer E Flythe, Matthew J Tugman, Emily H Chang, Brent R Brown, Amanda K Leonberg-Yoo, Ryan C Spiardi, Todd A Miano, Meaghan S Roche, Charles R Vasquez, Amar D Bansal, Natalie C Ernecoff, Sanjana Kapoor, Siddharth Verma, Huiwen Chen, Csaba P Kovesdy, Miklos Z Molnar, Ambreen Azhar, S Susan Hedayati, Mridula V Nadamuni, Shani Shastri, Duwayne L Willett, Samuel A P Short, Amanda D Renaghan, Kyle B Enfield, Pavan K Bhatraju, A Bilal Malik, Matthew W Semler, Anitha Vijayan, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F Kao, Greg L Schumaker, Nitender Goyal, Anthony J Faugno, Greg L Schumaker, Caroline M Hsu, Asma Tariq, Leah Meyer, Ravi K Kshirsagar, Daniel E Weiner, Marta Christov, Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, Savneek Chugh, Perry Wilson, Tanima Arora, Ugochukwu Ugwuowo

Affiliations

¹ Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (H.A., R.K.L., R.P.R.).
² Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.G., D.E.L.).
³ Brigham and Women's Hospital, Boston, Massachusetts (W.W.).
⁴ Heart and Vascular Hospital, Hackensack Meridian Health Hackensack University Medical Center, Hackensack, New Jersey (S.K.B.).
⁵ University of Michigan Medical Center, Ann Arbor, Michigan (S.S.H., H.B.).
⁶ Indiana University School of Medicine, Indianapolis, Indiana (R.K.).
⁷ Beth Israel Deaconess Medical Center, Boston, Massachusetts (S.S.).
⁸ Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.L.M.).
⁹ Rutgers New Jersey Medical School, Newark, New Jersey (A.S.).
¹⁰ Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.R.).
¹¹ Cooper University Health Care, Camden, New Jersey (A.G.).
¹² Johns Hopkins School of Medicine, Baltimore, Maryland (B.T.G.).
¹³ Center for Translational Metabolism and Health, Institute for Public Health and Medicine, and Northwestern University Feinberg School of Medicine, Chicago, Illinois (A.S.).
¹⁴ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.L.).
¹⁵ Hackensack Meridian Health Mountainside Medical Center, Glen Ridge, New Jersey (A.M.S.).
¹⁶ University of North Carolina Kidney Center, UNC School of Medicine, and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina (J.E.F.).
¹⁷ University Hospitals Cleveland Medical Center, Cleveland, Ohio (A.R.).
¹⁸ Tufts Medical Center, Boston, Massachusetts (N.G.).
¹⁹ Icahn School of Medicine at Mount Sinai, New York, New York (L.C., K.S.M.).
²⁰ University of Texas Southwestern Medical Center, Dallas, Texas (S.S.H.).
²¹ University Medical Center of Southern Nevada Hospital, University of Nevada, Las Vegas, Nevada (R.D.).
²² University of Illinois Hospital at Chicago, Chicago, Illinois (S.M.T.).
²³ Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (J.Z.).
²⁴ Kings County Hospital Center, New York City Health and Hospital Corporation, Brooklyn, New York (M.M.).
²⁵ ProMedica Research, ProMedica Toledo Hospital, Toledo, Ohio (R.E.R.).
²⁶ University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.D.B.).
²⁷ University of Vermont Larner College of Medicine, Burlington, Vermont (S.A.S.).
²⁸ Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts (M.G.V.).
²⁹ University of Michigan, Ann Arbor, Michigan (A.J.A.).
³⁰ Vanderbilt University Medical Center, Nashville, Tennessee (M.W.S.).
³¹ Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.A.B.).
³² Harvard T.H. Chan School of Public Health and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts (M.A.H.).

PMID: 33493012
PMCID: PMC7863679
DOI: 10.7326/M20-6739

Erratum in

Correction: Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19.
[No authors listed] [No authors listed] Ann Intern Med. 2021 Jun;174(6):888. doi: 10.7326/L21-0148. Ann Intern Med. 2021. PMID: 34126034 No abstract available.

Abstract

Background: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).

Objective: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival.

Design: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used.

Setting: 67 hospitals in the United States.

Participants: Adults with COVID-19 admitted to a participating ICU.

Measurements: Time to death, censored at hospital discharge, or date of last follow-up.

Results: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]).

Limitation: Observational design.

Conclusion: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.

Primary funding source: None.

PubMed Disclaimer

Conflict of interest statement

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-6739.

Figures

**Visual Abstract.. Early Anticoagulation in COVID-19**
Hypercoagulability may be a key mechanism of death in patients with COVID-19. This cohort study evaluated the incidence of venous thromboembolism and major bleeding in critically ill patients with COVID-19 and examined the observational effect of early therapeutic anticoagulation on survival.

**Figure 1.. Flow diagram for target trial emulation of therapeutic anticoagulation.**
COVID-19 = coronavirus disease 2019; DVT = deep venous thrombosis; ECMO = extracorporeal membrane oxygenation; ICU = intensive care unit; PE = pulmonary embolism.

**Figure 2.. Target trial emulation.**
Survival in patients who received therapeutic anticoagulation in the first 2 days of ICU admission compared with those who did not. AC = anticoagulation; ICU = intensive care unit.

**Figure 3.. Results of sensitivity and subgroup analyses.**
Shown are the hazard ratios for survival according to early initiation of therapeutic AC versus no early initiation of therapeutic AC in the primary analysis, the sensitivity analyses, and across subgroups. AC = anticoagulation; HR = hazard ratio; ICU = intensive care unit.

See this image and copyright information in PMC

Comment in

[Anticoagulation in SARS-CoV-2 infection: state of the art and management in patients with home treatment].
Bracamonte-Hernández JJ, Arquinigo-Lavado IR, Ramírez-Meyhuay DC, Pichardo-Rodriguez R. Bracamonte-Hernández JJ, et al. Rev Chilena Infectol. 2021 Jun;38(3):461-462. doi: 10.4067/S0716-10182021000300461. Rev Chilena Infectol. 2021. PMID: 34479307 Spanish. No abstract available.

References

1. Tremblay D , van Gerwen M , Alsen M , et al. Impact of anticoagulation prior to COVID-19 infection: a propensity score-matched cohort study [Letter]. Blood. 2020;136:144-147. [PMID: ] doi:10.1182/blood.2020006941 - DOI - PMC - PubMed
1. Lala A , Johnson KW , Januzzi JL , et al; Mount Sinai COVID Informatics Center. Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection. J Am Coll Cardiol. 2020;76:533-546. [PMID: ] doi:10.1016/j.jacc.2020.06.007 - DOI - PMC - PubMed
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Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

Collaborators

Affiliations

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

Authors

Collaborators

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical