Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry.
Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry.
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DOI：
10.1002/jmv.26918
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发表时间：
2021-07
影响因子：
12.7
通讯作者：
Soundararajan V
中科院分区：
文献类型：
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作者：
Kirkup C;Pawlowski C;Puranik A;Conrad I;O'Horo JC;Gomaa D;Banner-Goodspeed VM;Mosier JM;Zabolotskikh IB;Daugherty SK;Bernstein MA;Zaren HA;Bansal V;Pickering B;Badley AD;Kashyap R;Venkatakrishnan AJ;Soundararajan V
在这里，我们分析了来自国际病毒登记处（https：//clinicaltrials.gov/ct2/show/NCT04323787）的住院和重症监护病房2019冠状病毒病（COVID-19）患者结局。我们发现，使用普通肝素而不是依诺肝素的COVID-19患者的死亡率更高（390/1012 = 39%）与使用依诺肝素但未使用普通肝素的患者（270/1939 = 14%）相比，风险比为2.79（95%置信区间[CI]：[2.42，3.16]; p = 4.45e−52）。即使在平衡了一些协变量（包括人口统计学、合并症、入院诊断和氧合方法）后，这种差异仍然存在，出院时死亡率增加37%普通肝素组为268/733例，依诺肝素组为22%（154/711例），风险比为1.69（95% CI：[1.42，2.00]; p = 1.5e−8）。在这些平衡队列中，与接受依诺肝素的患者相比，接受普通肝素的患者的许多并发症发生率升高，包括急性肾损伤、急性心脏损伤、感染性休克和贫血。此外，与白色/高加索COVID患者（671/2644 [25%]）相比，黑人/非裔美国人COVID患者（414/1294 [32%]）接受普通肝素的比例更高，风险比为1.26（95% CI：[1.14，1.40]; p = 7.5e−5）。在对可用的临床协变量进行平衡后，抗凝剂使用的差异仍具有统计学显著性（黑人/非裔美国人311/1047 [30%] vs.白色/高加索人263/1047 [25%]，p = 0.02，风险比1.18; 95% CI：[1.03，1.36]）。虽然回顾性研究不能表明任何因果关系，但这些发现促使我们需要对严重COVID-19患者在抗凝剂使用和结局方面观察到的种族差异进行随访前瞻性研究。
Here we analyze hospitalized andintensive care unit coronavirus disease 2019 (COVID‐19) patient outcomes from the international VIRUS registry (https://clinicaltrials.gov/ct2/show/NCT04323787). We find that COVID‐19 patients administered unfractionated heparin but not enoxaparin have a higher mortality‐rate (390 of 1012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1939 = 14%), presenting a risk ratio of 2.79 (95% confidence interval [CI]: [2.42, 3.16]; p = 4.45e−52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin versus 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% CI: [1.42, 2.00]; p = 1.5e−8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2644 [25%]), risk ratio 1.26 (95% CI: [1.14, 1.40]; p = 7.5e−5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1047 [30%] for Black/African American vs. 263 of 1047 [25%] for White/Caucasian, p = .02, risk ratio 1.18; 95% CI: [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow‐up prospective research into the observed racial disparity in anticoagulant use and outcomes for severe COVID‐19 patients.
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影响因子：
5.6
作者：
Holtgrave, David R.;Barranco, Meredith A.;Rosenberg, Eli S.
通讯作者：
Rosenberg, Eli S.
三个治疗组倾向得分匹配的最佳卡尺宽度：蒙特卡罗研究
影响因子：
3.7
作者：
Wang Y;Cai H;Li C;Jiang Z;Wang L;Song J;Xia J
通讯作者：
Xia J
影响因子：
9.6
作者：
Rajter JC;Sherman MS;Fatteh N;Vogel F;Sacks J;Rajter JJ
通讯作者：
Rajter JJ
DOI：
10.1111/jth.14817
发表时间：
2020-05
期刊：
Journal of thrombosis and haemostasis : JTH
影响因子：
--
作者：
通讯作者：
--
影响因子：
5.3
作者：
Caliendo, Marco;Kopeinig, Sabine
通讯作者：
Kopeinig, Sabine