Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 May 1;53(5):afae094.
doi: 10.1093/ageing/afae094.

The effect of current antithrombotic therapy on mortality in nursing home residents with COVID-19: a multicentre retrospective cohort study

Firdaouss Boutkourt  1   2 , Thijs van Haaps  3   4 , Reneé Brüggemann  5 , Soerajja Bhoelan  6 , Hugo Ten Cate  5 , Marieke J H A Kruip  7 , Bart Spaetgens  5 , Nick van Es  3   4 , Tineke Roest  2 , Karlijn J Joling  8 , Karina Meijer  6 , Jacqueline Hugtenburg  1
Affiliations
Multicenter Study

The effect of current antithrombotic therapy on mortality in nursing home residents with COVID-19: a multicentre retrospective cohort study

Firdaouss Boutkourt et al. Age Ageing. .

Abstract

Background: The first wave of COVID led to an alarmingly high mortality rate among nursing home residents (NHRs). In hospitalised patients, the use of anticoagulants may be associated with a favourable prognosis. However, it is unknown whether the use of antithrombotic medication also protected NHRs from COVID-19-related mortality.

Objectives: To investigate the effect of current antithrombotic therapy in NHRs with COVID-19 on 30-day all-cause mortality during the first COVID-19 wave.

Methods: We performed a retrospective cohort study linking electronic health records and pharmacy data in NHRs with COVID-19. A propensity score was used to match NHRs with current use of therapeutic dose anticoagulants to NHRs not using anticoagulant medication. The primary outcome was 30-day all-cause mortality, which was evaluated using a logistic regression model. In a secondary analysis, multivariable logistic regression was performed in the complete study group to compare NHRs with current use of therapeutic dose anticoagulants and those with current use of antiplatelet therapy to those without such medication.

Results: We included 3521 NHRs with COVID-19 based on a positive RT-PCR for SARS-CoV-2 or with a well-defined clinical suspicion of COVID-19. In the matched propensity score analysis, NHRs with current use of therapeutic dose anticoagulants had a significantly lower all-cause mortality (OR = 0.73; 95% CI: 0.58-0.92) compared to NHRs who did not use therapeutic anticoagulants. In the secondary analysis, current use of therapeutic dose anticoagulants (OR: 0.62; 95% CI: 0.48-0.82) and current use of antiplatelet therapy (OR 0.80; 95% CI: 0.64-0.99) were both associated with decreased mortality.

Conclusions: During the first COVID-19 wave, therapeutic anticoagulation and antiplatelet use were associated with a reduced risk of all-cause mortality in NHRs. Whether these potentially protective effects are maintained in vaccinated patients or patients with other COVID-19 variants, remains unknown.

Keywords: COVID-19; anticoagulants; antiplatelets; antithrombotic medication; mortality; nursing home residents; older people.

PubMed Disclaimer

Conflict of interest statement

Firdaouss Boutkourt, Thijs van Haaps, Reneé Brüggemann, Soerajja Bhoelan, Bart Spaetgens, Nick van Es, Tineke Roest, Karlijn J. Joling and Jacqueline Hugtenburg have no relevant financial or non-financial interests to disclose. Dr M.J.H.A. Kruip received speakers fee from Sobi, BMS and Roche all paid to the institution (Erasmus MC) and an unrestricted grant by Sobi, payment to institution (Erasmus MC). Dr Meijer reports speaker fees from Alexion, Bayer and CSL Behring, participation in trial steering committees for Bayer and Astra Zeneca, consulting fees from Uniqure, participation in data monitoring and endpoint adjudication committee for Octapharma. Dr Hugo ten Cate received consultancy fees from Alveron, Novostia, Astra Zeneca and Galapagos and is a shareholder at Coagulation Profile; all revenues deposited at the CARIM institute for research.

Figures

Figure 1
Figure 1
Study population before matching. Current use of antithrombotic therapy was defined as the use in the last 30 days before start of COVID-19.
Figure 2
Figure 2
Study population before and after matching. Current use of antithrombotic therapy was defined as the use in the last 30 days before start of COVID-19.
Figure 3
Figure 3
Survival probability curve after matching.
See this image and copyright information in PMC

References

    1. Middeldorp S, Coppens M, Haaps TFet al. . Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020; 18: 1995–2002. - PMC - PubMed
    1. Klok FA, Kruip M, Meer NJMet al. . Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145–7. - PMC - PubMed
    1. Lodigiani C, Iapichino G, Carenzo Let al. . Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020; 191: 9–14. - PMC - PubMed
    1. Perepu US, Chambers I, Wahab Aet al. . Standard prophylactic versus intermediate dose enoxaparin in adults with severe COVID-19: a multi-center, open-label, randomized controlled trial. J Thromb Haemost 2021; 19: 2225–34. - PMC - PubMed
    1. Investigators I, Sadeghipour P, Talasaz AHet al. . Effect of intermediate-dose vs standard-dose prophylactic anticoagulation on thrombotic events, extracorporeal membrane oxygenation treatment, or mortality among patients with COVID-19 admitted to the intensive care unit: the INSPIRATION randomized clinical trial. JAMA 2021; 325: 1620–30. - PMC - PubMed

Publication types