Chronic anti-coagulation therapy reduced mortality in patients with high cardiovascular risk early in COVID-19 pandemic.
Chronic anti-coagulation therapy reduced mortality in patients with high cardiovascular risk early in COVID-19 pandemic.
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DOI：
10.1186/s12959-023-00460-z
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发表时间：
2023-01-30
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
--
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2019冠状病毒病（COVID-19）与引发的血栓炎症反应有关。在2019冠状病毒病大流行的早期，这被认为是导致感染患者高凝状态和多器官系统并发症的原因。有限的研究评估了治疗性抗凝治疗（AC）在缓解COVID-19阳性患者中这些风险方面的影响。我们的研究旨在调查长期治疗性AC是否可以降低美国大流行早期住院的COVID-19阳性患者的多器官系统并发症（MOSC）风险，包括卒中、肢体缺血、胃肠道（GI）出血、院内和重症监护室死亡。对2020年3月至2020年10月期间所有COVID-19阳性的美国退伍军人进行了回顾性分析。在首次COVID-19检测呈阳性之前接受持续门诊治疗AC至少90天的患者被分配到AC组。未接受AC的患者被纳入对照组。我们使用二元逻辑回归分析（比值比; OR）分析AC组和对照组之间MOSC的主要研究结局。我们确定了48，066名COVID-19患者，其中879名（1.8%）正在接受持续治疗性AC。AC队列的合并症显著差于对照组。在校正的二元logistic回归模型中，治疗性AC显著降低了住院死亡率（OR; 0.67，p = 0.04），尽管GI出血的发生率较高（OR; 4.00，p = 0.02）。然而，治疗性AC并未显著减少其他不良事件。AC疗法减少了在COVID-19大流行早期因感染住院的患者的院内死亡。 然而，它并没有降低MOSC的风险。需要进行更多的试验来确定AC在预防与持续出现的COVID-19病毒株相关的并发症方面的有效性。在线版本包含补充材料，可通过10.1186/s12959 - 023 - 00460-z获得。
Coronavirus disease 2019 (COVID-19) is associated with provoked thrombo-inflammatory responses. Early in the COVID-19 pandemic this was thought to contribute to hypercoagulability and multi-organ system complications in infected patients. Limited studies have evaluated the impact of therapeutic anti-coagulation therapy (AC) in alleviating these risks in COVID-19 positive patients. Our study aimed to investigate whether long-term therapeutic AC can decrease the risk of multi-organ system complications (MOSC) including stroke, limb ischemia, gastrointestinal (GI) bleeding, in-hospital and intensive care unit death in COVID-19 positive patients hospitalized during the early phase of the pandemic in the United States. A retrospective analysis was conducted of all COVID-19 positive United States Veterans between March 2020 and October 2020. Patients receiving continuous outpatient therapeutic AC for a least 90 days prior to their initial COVID-19 positive test were assigned to the AC group. Patients who did not receive AC were included in a control group. We analyzed the primary study outcome of MOSC between the AC and control groups using binary logistic regression analysis (Odd-Ratio; OR). We identified 48,066 COVID-19 patients, of them 879 (1.8%) were receiving continuous therapeutic AC. The AC cohort had significantly worse comorbidities than the control group. On the adjusted binary logistic regression model, therapeutic AC significantly decreased in-hospital mortality rate (OR; 0.67, p = 0.04), despite a higher incidence of GI bleeding (OR; 4.00, p = 0.02). However, therapeutic AC did not significantly reduce other adverse events. AC therapy reduced in-hospital death early in the COVID-19 pandemic among patients who were hospitalized with the infection. However, it did not decrease the risk of MOSC. Additional trials are needed to determine the effectiveness of AC in preventing complications associated with ongoing emerging strains of the COVID-19 virus. The online version contains supplementary material available at 10.1186/s12959-023-00460-z.
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