Association of anticoagulation dose and survival in hospitalized COVID-19 patients: A retrospective propensity score-weighted analysis
Association of anticoagulation dose and survival in hospitalized COVID-19 patients: A retrospective propensity score-weighted analysis
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DOI：
10.1111/ejh.13533
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发表时间：
2020-11-04
影响因子：
3.1
通讯作者：
Nair, Girish B.
中科院分区：
文献类型：
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作者：
Ionescu, Filip;Jaiyesimi, Ishmael;Nair, Girish B.
背景高凝状态可能有助于COVID-19的致病性。抗凝治疗（tAC）或预防剂量（pAC）的作用尚不清楚。目的我们评估了不同AC剂量对COVID-19患者生存的影响。方法回顾性、多中心队列研究，对2020年3月13日至5月5日期间连续住院的COVID-19患者进行研究。结果共纳入3480例患者，（平均年龄：64.5岁[17.0]; 51.5%为女性; 52.1%为黑人，40.6%为白色）。18.5%（n = 642）需要入住重症监护室（ICU）。60.9%接受pAC（n = 2121），28.7%接受≥ 3天tAC（n = 998），10.4%（n = 361）未接受AC。倾向评分（PS）加权Kaplan-Meier图显示tAC和pAC组的25天生存概率不同（57.5% vs 50.7%）。在PS加权多变量比例风险模型中，与无AC相比，AC与预防性（风险比[HR] 0.35 [95%置信区间{CI} 0.22-0.54]）和治疗剂量（HR 0.14 [95% CI 0.05-0.23]）下的死亡风险降低相关。tAC患者（81 [8.1%]）的大出血发生率高于无AC（20 [5.5%]）或pAC（46 [2.2%]）受试者。结论较高剂量的AC与住院COVID-19患者的死亡率较低相关。有必要对AC在COVID-19中的疗效和风险进行前瞻性评估。
Background Hypercoagulability may contribute to COVID-19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear.Objectives We evaluated the impact on survival of different AC doses in COVID-19 patients.Methods Retrospective, multi-center cohort study of consecutive COVID-19 patients hospitalized between March 13 and May 5, 2020.Results A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n = 642) required intensive care unit (ICU) stay. 60.9% received pAC (n = 2121), 28.7% received >= 3 days of tAC (n = 998), and 10.4% (n = 361) received no AC. Propensity score (PS) weighted Kaplan-Meier plot demonstrated different 25-day survival probability in the tAC and pAC groups (57.5% vs 50.7%). In a PS-weighted multivariate proportional hazards model, AC was associated with reduced risk of death at prophylactic (hazard ratio [HR] 0.35 [95% confidence interval {CI} 0.22-0.54]) and therapeutic doses (HR 0.14 [95% CI 0.05-0.23]) compared to no AC. Major bleeding occurred more frequently in tAC patients (81 [8.1%]) compared to no AC (20 [5.5%]) or pAC (46 [2.2%]) subjects.Conclusions Higher doses of AC were associated with lower mortality in hospitalized COVID-19 patients. Prospective evaluation of efficacy and risk of AC in COVID-19 is warranted.