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. 2024 Jan 4;22(1):5.
doi: 10.1186/s12959-023-00572-6.

Association between antithrombotic therapy and mortality in patients hospitalized for COVID‑19

Xing Wang #  1 , Wuqian Chen #  1 , Jiulin Guo  2 , Xingyu Qiu  1 , Chao You  1 , Lu Ma  3
Affiliations

Association between antithrombotic therapy and mortality in patients hospitalized for COVID‑19

Xing Wang et al. Thromb J. .

Abstract

Background: The prothrombotic state is a common abnormality in patients with coronavirus disease 2019 (COVID-19). However, there is controversy over the use of anticoagulants, especially oral anticoagulants (OAC) due to limited studies. We sought to evaluate the association between antithrombotic therapy on mortality and clinical outcomes in patients hospitalized for COVID-19 through propensity score matching (PSM) analysis.

Methods: A retrospective cohort study was performed to include adult patients with COVID-19 in a university hospital. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and acute kidney injury (AKI) during hospitalization. PSM was used as a powerful tool for matching patients' baseline characteristics. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated from the models.

Results: Of 4,881 COVID-19 patients during the study period, 690 (14.1%) patients received antithrombotic therapy and 4,191 (85.9%) patients were under no antithrombotic therapy. After adjustment with multivariate regression analysis, patients receiving OAC, compared with those who did not receive any antithrombotic therapy, had significantly lower odds for in-hospital mortality (aOR: 0.46. 95% CI: 0.24 to 0.87; P= 0.017). PSM analysis observed similar results (aOR: 0.35. 95% CI: 0.19 to 0.61; P< 0.001). Moreover, in critically ill patients who received mechanical ventilation, antithrombotic treatment (aOR: 0.54. 95% CI: 0.32 to 0.89; P= 0.022) was associated with reduced risk of mortality.

Conclusions: The application OACs was associated with reduced hospital mortality and mechanical ventilation requirement in COVID-19 patients. Besides, antithrombotic treatment was associated with a reduction in in-hospital mortality among critically ill COVID-19 patients who required mechanical ventilation.

Keywords: Anticoagulants; Antiplatelet; COVID- 19; Critical Illness; Mortality.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Propensity score matching effect evaluated by a dot plot. Red dots indicate the standard mean differences before matching; green dots indicate that after matching
Fig. 2
Fig. 2
Subgroup analyses of antithrombotic therapy for in-hospital mortality. The analyses were performed using the matching data
Fig. 3
Fig. 3
Comparison of antithrombotic therapy vs. no antithrombotic therapy on mortality, ICU admission, and AKI in COVID-19 patients receiving mechanical ventilation
See this image and copyright information in PMC

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